[House Hearing, 118 Congress]
[From the U.S. Government Publishing Office]
EXAMINING EXISTING FEDERAL PROGRAMS TO
BUILD A STRONGER HEALTH WORKFORCE AND
IMPROVE PRIMARY CARE
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON ENERGY AND
COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED EIGHTEENTH CONGRESS
FIRST SESSION
__________
APRIL 19, 2023
__________
Serial No. 118-24
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Published for the use of the Committee on Energy and Commerce
govinfo.gov/committee/house-energy
energycommerce.house.gov
------
U.S. GOVERNMENT PUBLISHING OFFICE
55-100 PDF WASHINGTON : 2024
COMMITTEE ON ENERGY AND COMMERCE
CATHY McMORRIS RODGERS, Washington
Chair
MICHAEL C. BURGESS, Texas FRANK PALLONE, Jr., New Jersey
ROBERT E. LATTA, Ohio Ranking Member
BRETT GUTHRIE, Kentucky ANNA G. ESHOO, California
H. MORGAN GRIFFITH, Virginia DIANA DeGETTE, Colorado
GUS M. BILIRAKIS, Florida JAN SCHAKOWSKY, Illinois
BILL JOHNSON, Ohio DORIS O. MATSUI, California
LARRY BUCSHON, Indiana KATHY CASTOR, Florida
RICHARD HUDSON, North Carolina JOHN P. SARBANES, Maryland
TIM WALBERG, Michigan PAUL TONKO, New York
EARL L. ``BUDDY'' CARTER, Georgia YVETTE D. CLARKE, New York
JEFF DUNCAN, South Carolina TONY CARDENAS, California
GARY J. PALMER, Alabama RAUL RUIZ, California
NEAL P. DUNN, Florida SCOTT H. PETERS, California
JOHN R. CURTIS, Utah DEBBIE DINGELL, Michigan
DEBBBIE LESKO, Arizona MARC A. VEASEY, Texas
GREG PENCE, Indiana ANN M. KUSTER, New Hampshire
DAN CRENSHAW, Texas ROBIN L. KELLY, Illinois
JOHN JOYCE, Pennsylvania NANETTE DIAZ BARRAGAN, California
KELLY ARMSTRONG, North Dakota, Vice LISA BLUNT ROCHESTER, Delaware
Chair DARREN SOTO, Florida
RANDY K. WEBER, Sr., Texas ANGIE CRAIG, Minnesota
RICK W. ALLEN, Georgia KIM SCHRIER, Washington
TROY BALDERSON, Ohio LORI TRAHAN, Massachusetts
RUSS FULCHER, Idaho LIZZIE FLETCHER, Texas
AUGUST PFLUGER, Texas
DIANA HARSHBARGER, Tennessee
MARIANNETTE MILLER-MEEKS, Iowa
KAT CAMMACK, Florida
JAY OBERNOLTE, California
------
Professional Staff
NATE HODSON, Staff Director
SARAH BURKE, Deputy Staff Director
TIFFANY GUARASCIO, Minority Staff Director
Subcommittee on Health
BRETT GUTHRIE, Kentucky
Chairman
MICHAEL C. BURGESS, Texas ANNA G. ESHOO, California
ROBERT E. LATTA, Ohio Ranking Member
H. MORGAN GRIFFITH, Virginia JOHN P. SARBANES, Maryland
GUS M. BILIRAKIS, Florida TONY CARDENAS, California
BILL JOHNSON, Ohio RAUL RUIZ, California
LARRY BUCSHON, Indiana, Vice Chair DEBBIE DINGELL, Michigan
RICHARD HUDSON, North Carolina ANN M. KUSTER, New Hampshire
EARL L. ``BUDDY'' CARTER, Georgia ROBIN L. KELLY, Illinois
NEAL P. DUNN, Florida NANETTE DIAZ BARRAGAN, California
GREG PENCE, Indiana LISA BLUNT ROCHESTER, Delaware
DAN CRENSHAW, Texas ANGIE CRAIG, Minnesota
JOHN JOYCE, Pennsylvania KIM SCHRIER, Washington
DIANA HARSHBARGER, Tennessee LORI TRAHAN, Massachusetts
MARIANNETTE MILLER-MEEKS, Iowa FRANK PALLONE, Jr., New Jersey (ex
JAY OBERNOLTE, California officio)
CATHY McMORRIS RODGERS, Washington
(ex officio)
C O N T E N T S
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Page
Hon. Brett Guthrie, a Representative in Congress from the
Commonwealth of Kentucky, opening statement.................... 1
Prepared statement........................................... 4
Hon. Anna G. Eshoo, a Representative in Congress from the State
of California, opening statement............................... 6
Prepared statement8..........................................
Hon. Cathy McMorris Rodgers, a Representative in Congress from
the State of Washington, opening statement..................... 10
Prepared statement........................................... 12
Hon. Frank Pallone, Jr., a Representative in Congress from the
State of New Jersey, opening statement......................... 16
Prepared statement........................................... 18
Witness
Carole Johnson, Administrator, Health Resources and Services
Administration, Department of Health and Human Services........ 20
Prepared statement........................................... 23
Questions submitted for the record \1\....................... 177
Legislation
H.R. 2559, the Strengthening Community Care Act of 2023.......... 76
H.R. ___, a Bill to reauthorize a program of payments to Teaching
Health Centers that operate Graduate Medical Education
programs, and for other purposes............................... 78
H.R. 2569, the Doctors of Community (DOC) Act.................... 81
H.R. 2547, the Special Diabetes Program for Indians
Reauthorization Act of 2023.................................... 84
H.R. 2550, the Special Diabetes Program Reauthorization Act of
2023........................................................... 86
H.R. 2544, the Securing the U.S. Organ Procurement and
Transplantation Network Act.................................... 88
H.R. 2411, the National Nursing Workforce Center Act of 2023..... 92
H.R. ___, a Bill to amend the Public Health Service Act with
respect to the Covered Countermeasure Process Fund, and for
other purposes................................................. 103
Submitted Material
Inclusion of the following was approved by unanimous consent.
List of documents submitted for the record....................... 107
Statement of Traci Couture Richmond, Executive Director, Spokane
Teaching Health Center, April 19, 2023......................... 108
Letter of April 19, 2023, from Mary R. Grealy, President,
Healthcare Leadership Council, to Mr. Guthrie and Ms. Eshoo.... 113
Statement of the National Indian Health Board, April 19, 2023.... 116
Letter of April 19, 2023, from Christopher S. Kang, President,
American College of Emergency Physicians, to Mr. Guthrie and
Ms. Eshoo...................................................... 120
Statement of Lori J. Pierce, President, Association for Clinical
Oncology, April 19, 2023....................................... 123
----------
\1\ Ms. Johnson did not answer submitted questions for the record by
the time of publication. Replies received after publication will be
retained in committee files and made available at https://
docs.house.gov/Committee/Calendar/ByEvent.aspx?EventID=115759.
Statement of the American College of Obstetricians and
Gynecologists, April 19, 2023.................................. 129
Statement of the Lone Star Family Health Center, Conroe, Texas... 136
Statement of Hon. Young Kim, a Representative in Congress from
the State of California, April 19, 2023........................ 137
Letter of April 17, 2023, from Garrett Chan, President and Chief
Executive Officer, HealthImpact, to Mrs. Rodgers and Mr.
Guthrie........................................................ 139
Letter of April 19, 2023, from Marina Zhavoronkova, Senior
Fellow, Workforce Development, and Bradley Custer, Senior
Policy Analyst, Higher Education, Center for American Progress,
to Mrs. Rodgers and Mr. Pallone................................ 143
Letter of April 18, 2023, from George R. Sheply, President, and
Raymond A. Cohlmia, Executive Director, American Dental
Association, to Mr. Pallone.................................... 145
Letter of April 19, 2023, from Sterling N. Ransone, Jr., Board
Chair, American Academy of Family Physicians, to Mr. Guthrie
and Ms. Eshoo.................................................. 146
Statement of the Association of American Medical Colleges, April
19, 2023....................................................... 155
Letter of April 18, 2023, from Clifton Porter II, Senior Vice
President, Government Relations, American Health Care
Association, to Mrs. Rodgers and Mr. Pallone................... 162
Letter of April 19, 2023, from Lanelle Weems, President, Board of
Directors, National Forum of State Nursing Workforce Centers,
to Mrs. Rodgers and Mr. Pallone................................ 164
Statement of the PA Education Association, April 19, 2023........ 167
Statement of the American Hospital Association, April 19, 2023... 170
Letter of April 17, 2023, from D. Scott Casanover, General
Counsel/Senior Vice President of Government Affairs, West Coast
University, to Rep. Young Kim.................................. 176
EXAMINING EXISTING FEDERAL PROGRAMS
TO BUILD A STRONGER HEALTH WORKFORCE
AND IMPROVE PRIMARY CARE
----------
WEDNESDAY, APRIL 19, 2023
House of Representatives,
Subcommittee on Health,
Committee on Energy and Commerce,
Washington, DC.
The subcommittee met, pursuant to call, at 10:01 a.m., in
the John D. Dingell Room 2123, Rayburn House Office Building,
Hon. Brett Guthrie (chairman of the subcommittee) presiding.
Members present: Representatives Guthrie, Burgess, Latta,
Griffith, Bilirakis, Johnson, Bucshon, Hudson, Carter, Pence,
Crenshaw, Joyce, Harshbarger, Miller-Meeks, Rodgers (ex
officio), Eshoo (subcommittee ranking member), Sarbanes,
Cardenas, Ruiz, Kuster, Kelly, Barragan, Blunt Rochester,
Craig, Schrier, and Pallone (ex officio).
Staff present: Kate Arey, Digital Director; Jolie Brochin,
Clerk, Health; Sarah Burke, Deputy Staff Director; Kristin
Flukey, Professional Staff Member, Health; Grace Graham, Chief
Counsel, Health; Sydney Greene, Director of Operations; Nate
Hodson, Staff Director; Tara Hupman, Chief Counsel; Peter
Kielty, General Counsel; Emily King, Member Services Director;
Molly Lolli, Counsel, Health; Emma Schultheis, Staff Assistant;
Michael Taggart, Policy Director; Lydia Abma, Minority Policy
Analyst; Waverly Gordon, Minority Deputy Staff Director and
General Counsel; Tiffany Guarascio, Minority Staff Director;
Una Lee, Minority Chief Health Counsel; Juan Negrete, Minority
Professional Staff Member; and Rick Van Buren, Minority Senior
Health Counsel.
Mr. Guthrie. The subcommittee will come to order.
The Chair recognizes himself for an opening statement.
OPENING STATEMENT OF HON. BRETT GUTHRIE, A REPRESENTATIVE IN
CONGRESS FROM THE COMMONWEALTH OF KENTUCKY
Today the healthcare subcommittee is taking an important
step in reauthorizing critical programs within the Health
Resources and Services Administration. The policies before us
today each play a unique role in providing greater access to
care for millions of Americans, particularly those in rural and
underserved communities. Many of these programs expire on
September 30th. By taking early action, we are providing
reassurance that they can continue without disruption.
Early action also provides subcommittee members with the
chance to review the impact of--the policies are currently
having, and ensure all future funds are directed in the most
effective and appropriate way possible. It also gives us time
to work together and find bipartisan offsets for mandatory
spending in future years.
The first bill, the Strengthening Community Care Act of
2023, would extend the Community Healthcare Fund and the
National Health Service Corps through 2028. Both programs allow
millions of Americans across the country in medically
underserved communities to receive access to high-quality
primary care services, including pharmacy, mental health,
substance use disorder, and dental care services.
Across Kentucky, HRSA's Uniform Data System data shows that
25 health systems received grant funding in 2021. Nearly
600,000 patients were served, many of which were served by
providers who participated in the National Health Service
Corps.
I want to thank Dr. Joyce for leading on this important
issue, especially at a time in which we are facing primary care
provider shortages across the Nation.
I am hopeful we can come to a bipartisan agreement on a
path forward to extend funding and--on the necessary offsets
for the Teaching Health Care Center Graduate Medical Education
program. I am committed to working with my colleagues to
continue these essential programs. However, I do think we do
not make--should not make these programs permanent at this
time.
We are examining the National Nursing Workforce Center Act,
led by Representatives Kim and Blunt Rochester. This bill is
designed to help bolster our nursing workforce and would
specifically require HRSA to work with State nursing workforce
centers to help streamline their nursing workforce programs.
This would ultimately provide more targeted investments that
reflect the need of local communities.
I thank my colleagues for working on this bipartisan bill.
I also would like to thank Representative Blunt Rochester
for working with me on one of my nursing workforce priorities,
the Building America's Health Care Workforce Act. This would
address very serious nursing workforce shortages in the long-
term care community. I will continue my push to advance
legislation like this that cuts red tape, especially as we near
the expiration of the COVID-19 public health emergency on May
the 11th.
We will also consider proposals to provide continued access
to key programs for chronic conditions such as diabetes. The
Special Diabetes Program Reauthorization Act of 2023 and the
Special Diabetes Program for Indians Reauthorization Act will
provide continued funding for both programs through 2028. Over
1.6 million Americans living with Type 1 diabetes--these
programs will allow patients to continue receiving
comprehensive diabetes care, and will lead to a higher quality
of life and lower healthcare costs for patients.
I thank Representatives Bilirakis and Cole for leading on
these issues.
We are also considering legislation that will promote more
transparency and greater access to care for over 100,000
individuals in need of an organ transplant. Dr. Bucshon's
Securing the U.S. Organ Procurement and Transplantation Network
Act would ensure the Nation's organ procurement system is
operating more efficiently, which will ultimately lead to
greater access to organ transplants for vulnerable populations.
Lastly, we are examining a proposal to increase
transparency within the Covered Countermeasures Injury
Compensation program to help ensure claimants are receiving
adequate information in a timely manner.
I look forward to today's discussion. I thank the witnesses
for being here, for being with us today.
[The prepared statement of Mr. Guthrie follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Guthrie. And I yield back. The Chair now recognizes my
good friend from California, the ranking member of the
subcommittee, Ranking Member Eshoo, for 5 minutes for an
opening statement.
OPENING STATEMENT OF HON. ANNA G. ESHOO, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF CALIFORNIA
Ms. Eshoo. Thank you, Mr. Chairman.
And good morning, Administrator Johnson. Welcome back to
the Health Subcommittee, and thank you for your superb
leadership at the helm of the Health Resources and Services
Administration, overseeing more than 90 programs that improve
the health and well-being of all Americans. You head up the
agency with grantmaking, and it is the dispersal of those funds
in HHS that really make the policies dance. So thank you.
Today our subcommittee is considering eight bills to extend
critical public health programs, bolster the health workforce,
and address the broken organ transplant system. We are going to
hear testimony about five health programs that expire on
September 30th: Community Health Centers that are really core,
you know, operations in our congressional districts; the
National Health Service Corps; the Teaching Health Center
Graduate Medical Education program; the Special Diabetes
Program; and the Special Diabetes Program for Indians.
First, we are considering a bipartisan bill to extend
mandatory funding for Community Health Centers and the National
Health Service Corps for 5 years. The Community Health Center
Fund provides support to nearly 14,000 health center locations
across our country. These health centers provide primary care
to 1 in every 11 Americans. We cannot do without them--
including 1 in 5 Californians--regardless of their ability to
pay.
A Community Health Center in my district, the Asian
Americans for Community Involvement, provides a full spectrum
of care through a multilingual team of doctors, nurses, and
patient navigators. They have earned a superb reputation for
the care that they give to people in the community. And at this
health center the team can speak more than 40 languages to
ensure their services are responsive to cultural beliefs, to
practices, and preferred languages.
The National Health Service Corps is a highly effective
program that has been connecting providers to patients in need
for over five decades. I am disappointed that funding for these
programs is not adjusted for inflation, despite the clear need.
But I support the bipartisan reauthorization.
We are also considering programs to improve access to
primary care. We have to stay on this, because that is the
entrance to the entire healthcare system in our country,
including the Teaching Health Center GME Program and the
Special Diabetes Programs. They support viable primary care
workforce for low-income communities by providing residency--
and we spoke about this on the phone--residency training at
Federally qualified health centers.
The Affordable Care Act enabled the Teaching Health
Centers--can we not talk in the background here? It is
distracting. Please.
The Affordable Care Act enabled Teaching Health Centers to
train residents. Thirteen years later, these centers have
proven they can successfully train residents who will build
their practices in rural and underserved urban communities.
This is--you know, a giant bravo on this, because it really is
working. But funding for this program remains elusive and
inconsistent, preventing it from reaching its potential. I
support the legislation we are considering today to permanently
authorize the THC GME program and fund new training sites to
increase resident physician spots. And I believe that this
subcommittee can get to a bipartisan agreement on this
reauthorization.
The other expiring programs include Special Diabetes and
the Special Diabetes Program for Indians, which provide
critical investments in research and care for those living with
diabetes.
I have more to say, and I will say it as we move through
our hearing today because my time is almost up. But I want to
thank you for your leadership, and I want to thank you also for
sending out to each one of us--HRSA--in our congressional
districts, because this really brings it home about what HRSA
is doing, the grantmaking, and the difference that it is making
in the lives of our constituents.
[The prepared statement of Ms. Eshoo follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. Eshoo. So with that, Mr. Chairman, thank you for
holding the hearing, and I yield back.
Mr. Guthrie. Thank you----
Ms. Eshoo. And welcome to the chairwoman's daughters. Are
they still here? Right here.
Mr. Guthrie. Oh----
Ms. Eshoo. Oh, yes, yes.
Mrs. Rodgers. She outed you.
[Laughter.]
Ms. Eshoo. Yes, yes.
[Applause.]
Ms. Eshoo. Future women Members of the Congress.
Mr. Guthrie. Absolutely.
Ms. Eshoo. Yes.
Mr. Guthrie. We do welcome you here today, and I thank the
gentlelady for yielding back, and the Chair now recognizes the
chair of the full committee, Chair Rodgers, for 5 minutes for
an opening statement.
OPENING STATEMENT OF HON. CATHY McMORRIS RODGERS, A
REPRESENTATIVE IN CONGRESS FROM THE STATE OF WASHINGTON
Mrs. Rodgers. Thank you, Mr. Chairman. And I too would like
to welcome my two daughters, two most important advisors,
Brynn--Brynn Rodgers--and Grace Rodgers, who are on spring
break. It is great to have them in DC today.
Yes, so welcome to the Energy and Commerce Committee. Yes,
it is great to have you.
And also welcome to Carole Johnson, the Administrator for
the Health Services and--Health Resources and Services
Administration, known as HRSA. And I too want to say thanks for
the detailed district analysis that you have given each one of
us, and also coming to Spokane and spending some time in my
district.
Today we will discuss several existing Federal programs and
proposed legislation related to healthcare workforce, primary
care services, organ procurement, competition, countermeasure
injury compensation transparency, and diabetes research and
treatment.
The healthcare workforce shortage is leaving people without
the primary care they need, which is why we are considering the
Strengthening Community Care Act of 2023, led by Representative
Joyce. This legislation will reauthorize the Community Health
Center Fund and the National Health Services Corps that will
help support both primary care services and the healthcare
workforce.
I am especially proud of the work Community Health Centers
in my district are doing to expand services and increase job
opportunities. New Health currently offers a medical assistant
preapprenticeship program in partnership with local high
schools. They are also working with a local school district to
develop a workforce training center, where rural high school
students can gain access to clinical and nonclinical
internships.
Additionally, CHAS Health in Spokane is giving high school
students the opportunity to participate in training sessions
where they can learn about the different aspects of the health
clinic and related professions. I am hopeful that these efforts
will help bring more healthcare workers into our community.
Next we will discuss proposals to continue the Teaching
Health Center Graduate Medical Education Program funding. I am
a long-time supporter of this program, which helps to bring
more primary care doctors, OB-GYNs, mental health providers,
and others to rural areas. Spokane, Washington, has recognized
this and is a national leader on recruiting the next generation
of healthcare workers. The mandatory funding for this program
runs out September 30th, and I am committed to working to
extend it. I hope that we can come to a bipartisan agreement
and find the offsets needed.
We will also consider the National Nursing Workforce Center
Act of 2023, led by Representative Young Kim. This bill will
help enhance existing State-based nursing workforce centers so
that we can better access workforce challenges and address any
gaps.
I am thankful for Representative Bucshon's leadership on
the Securing of the U.S. Organ Procurement and Transplantation
Network Act. It will allow for HRSA to make the Organ
Procurement and Transplantation Network process more
competitive, with the ultimate goal of making organs available
to more people in need, one area where more work needs to be
done.
We will also consider a proposal to increase transparency
within the Countermeasures Injury Compensation Program. This is
administered by HRSA and provides compensation for covered
injuries or deaths that occur as a direct result of using
certain countermeasures used to treat ailments from a public
health emergency or security threat.
Lastly, we will discuss two programs critical to improve
the lives of people with diabetes, including Representative
Bilirakis' Special Diabetes Program Reauthorization Act of 2023
and Representative Cole's Special Diabetes Program for Indians
Reauthorization Act of 2023.
With that, I am looking forward to today's discussion, and
I yield back.
[The prepared statement of Mrs. Rodgers follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Guthrie. I thank the gentlelady. The Chair yields back.
The Chair now recognizes the ranking member of the full
committee, the gentleman from New Jersey, Mr. Pallone, for 5
minutes for an opening statement.
OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF NEW JERSEY
Mr. Pallone. Thank you, Mr. Chairman. Today the committee
continues its critical work of strengthening our healthcare
systems by building a stronger healthcare workforce and
improving access to primary care.
I am delighted that we will be considering my bill, the DOC
Act, which permanently authorizes and increases funding for the
Teaching Health Center Graduate Medical Education Program. And
this program supports the training of primary care medical and
dental residents in high-need communities. It is the only
Federal program that invests in this training of future
physicians in a community-based setting rather than a hospital
setting. And this is important for a number of reasons.
We know that physicians often choose to practice close to
their training sites. By moving primary care training into the
community, Teaching Health Centers help to address the
workforce shortages in underserved areas and increase access to
primary care.
This program has been incredibly successful since it was
established by the Affordable Care Act. Today there are 72
Teaching Health Center programs in 24 States, with 969 medical
residents handling more than 1 million patient visits annually
in rural and urban communities. It is because of this success
that the program has been reauthorized several times with
strong bipartisan support.
Reauthorization is critical, but oftentimes these
reauthorizations have often been short-term, leaving the
program in a state of uncertainty. The threat of expiration
makes it difficult for Teaching Health Centers to plan and
recruit for their residency programs. Low funding levels also
jeopardize the sustainability of programs and their ability to
address primary care workforce shortages in underserved areas.
Unfortunately, unlike the Medicare Graduate Medical
Education--GME--program, which funds GME slots and teaching
hospitals at over $16 billion a year, the Teaching Health
Centers program is not permanently authorized or funded, and my
bill provides the long-needed security that these programs have
asked for. It will create a reliable stream of doctors for
high-need communities with funding for 48 new programs across
the country, and creating an estimated 1,060 new residency
slots. It is still a tiny fraction of the GME slots that we
fund in teaching hospitals, but this kind of investment is
exactly what we need to increase access to primary care in
underserved areas.
We will also discuss legislation that will extend funding
for Community Health Centers, which provide primary care to
more than 30 million people across the country, including many
living in poverty and in rural areas. While I am disappointed
the funding included in this legislation today does not reflect
increases in the costs of providing care, it is critical that
we do not allow this funding to lapse. So I am pleased that the
legislation we are discussing today provides for long-term,
stable funding for these centers.
We will also examine legislation that will reauthorize
other expiring public health programs, including the Special
Diabetes Program and the Special Diabetes Program for Indians.
Both of these programs provide critical research and care. And
particularly the Special Diabetes Program for Indians funds
critical treatment and prevention efforts for American Indians
and Alaska Natives, who have the highest prevalence of diabetes
in this country.
I am also pleased that we will be considering legislation
introduced by Representative Blunt Rochester to address
shortages and bolster the nursing workforce by expanding State-
based nursing workforce centers and establishing a national
nursing-focused research center.
We will also discuss legislation that seeks to improve
existing programs at the Health Resources and Services
Administration, HRSA, including the Organ Procurement and
Transplantation Network, or OPTN. More than 6,000 Americans die
each year while waiting for organ transplants, and this problem
is even more pronounced for people of color and people in rural
communities. HRSA has undertaken a number of efforts to
modernize the OPTN, and the legislation before us today seeks
to complement those efforts. It would make OPTN contracts more
competitive in order to increase oversight and enhance the
performance of the program.
So I look forward to continuing work with my colleagues on
these important pieces of legislation, but I would like to once
again request that the committee immediately schedule a hearing
to examine the very real health impacts of all Americans by
these extremist right-wing judges who are attacking the Federal
drug approval process by the FDA.
Today we expect a decision from the Supreme Court, but the
decisions to date challenging FDA's decade-old approval of the
drug mifepristone are not grounded in science or in law. We
should hold a hearing on the detrimental impacts these
decisions could have on the drug approval process so we can
ensure Americans continue to have access to FDA-approved
medication.
There is no time to wait, and that is why every Democrat on
this committee has requested the Republican majority schedule a
hearing immediately. We must examine the very real impacts that
these dangerous court decisions could have on the American
people.
And with that, Mr. Chairman, I thank you, and I yield back.
[The prepared statement of Mr. Pallone follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Guthrie. I thank the gentleman for yielding back, and I
will--the Chair will move into witness testimony, and our
witness today is Carole Johnson, administrator of the Health
Resources and Services Administration at the Department of
Health and Human Services.
We appreciate you being here today and look forward to
discussing these bills before us with you. But you are now
recognized for 5 minutes for your opening statement.
STATEMENT OF CAROLE JOHNSON, ADMINISTRATOR, HEALTH RESOURCES
AND SERVICES ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN
SERVICES
Ms. Johnson. Thank you so much, Mr. Chairman.
Chair McMorris Rodgers, Ranking Member Pallone, Chair
Guthrie, Vice Chair Bucshon, Ranking Member Eshoo, and members
of the subcommittee, thank you for the opportunity to speak
with you today about improving primary care and the healthcare
workforce. I am Carole Johnson, Administrator of the Health
Resources and Services Administration, the agency of the
Department of Health and Human Services that supports
delivering healthcare in the Nation's highest-need communities,
building the healthcare workforce, improving maternal and child
health, supporting individuals with HIV, and meeting the
healthcare needs of rural America.
I would like to begin by thanking the subcommittee for your
longstanding bipartisan support for HRSA's programs. With your
help we have made significant gains in expanding access to
healthcare services, particularly in communities that have
struggled for far too long to recruit and retain healthcare
providers and access high-quality care. Yet we know there is
much more work to do.
I particularly appreciate the opportunity to focus today on
three vital programs HRSA--three vital HRSA programs that are
designed to help meet these needs. Mandatory funding for each
of these programs is expiring at the end of this fiscal year.
First, the Community Health Center program, which provides
high-quality, cost-effective care to 30 million people through
1,400 local healthcare centers, operating nearly 15,000 sites
that see patients regardless of their ability to pay. Health
centers are a vital source of care for individuals and families
who are uninsured, people who live in rural areas, folks who
are enrolled in Medicaid, and others who find it hard to find a
doctor or pay for the cost of care.
Second, the National Health Service Corps program, through
which we provide scholarships and loan repayment to students
and clinicians in return for them practicing in health
professional shortage areas. Last year, at a time of critical
workforce challenges across the country, we reached a historic
high of 20,000 National Health Service Corps clinicians
practicing in underserved and rural areas, thanks to this
program, as well as about 3,000 medical students currently
receiving National Health Service Corps scholarships in return
for their service commitment to practice in high-need
communities.
And third and finally, the Teaching Health Center Graduate
Medical Education program, which funds medical and dental
residency programs in settings like health centers, recognizing
that most primary care takes place in community settings, not
acute care hospitals. This fiscal year--by the end of this
fiscal year, we will have close to 1,100 primary care medical
and dental residents in training in these community settings,
with recruitment of new residents for a Resident Match Day 2024
beginning as early as this fall.
The President's fiscal year 2024 budget includes 3 years of
mandatory funding for each of these critical programs.
Multiyear funding will help to prevent disruptions in care or
training for millions of patients and thousands of students and
clinicians, while also giving health centers, medical
residents, and students predictability and confidence in the
sustainability of these programs as they grow.
With respect to health centers, the proposed budget
includes funding to sustain current services and reach more
people in need through longer hours and additional sites.
Importantly, the budget also recognizes the overwhelming need
to better integrate mental health and substance use disorder
services into primary care by both funding and requiring
behavioral health as a health center service.
With respect to the National Health Service Corps, the
budget would allow us to maintain the historic level of 20,000
providers currently practicing in health professional shortage
areas.
And for Teaching Health Centers, the budget would ensure no
disruption for current residents, allow Teaching Health Centers
to take on new residents as current cohorts complete their
training, and help programs with planning grants to--programs
that currently have planning grants to begin to come online.
I would like to emphasize the key point that clinicians who
are trained through these two programs tend to stay and
practice in rural and underserved communities, yielding a
valuable long-term return on the Federal Government's
investment in these programs.
I have recently had the opportunity to visit a host of
healthcare centers, including those that serve individuals
experiencing homelessness, school-based health center clinics,
health centers that are partners in our HIV work, in our Cancer
Moonshot work, and others that demonstrate how much health
centers are reflective of and trusted by the communities they
serve.
I have also had the opportunity to meet with National
Health Service Corps members who, to a person, report that
Health--the National Service Corps has helped enable them to
practice in the community where they want to serve, often a
rural community. And often, without National Health Service
Corps money, they would have had to make a different choice
about their practice.
In addition, I have had the good fortune to visit a couple
of Teaching Health Centers, both with Chair McMorris Rodgers,
and a planning grant awardee with Ranking Member Pallone to see
up close and in person how important this program is to the
next generation of the healthcare workforce, and really
building primary care in the communities where we want people
to serve.
These are just a few examples of the exciting and important
work happening in communities across the country as a result of
these critical programs. And I look forward to working closely
with the subcommittee to sustain and build on this work.
Thank you, and I look forward to your questions.
[The prepared statement of Ms. Johnson follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Guthrie. I thank the witness for her statement, and we
will now move to Member questions, and I will begin questioning
and recognizing myself for 5 minutes.
So Administrator Johnson, HRSA operates workforce
programming both in scholarship programs and loan repayment
programs, as we have discussed just recently--thanks for the
meeting--in exchange for individuals working in medically
underserved communities. So my--what I want to kind of explore
is staying in medical-served communities, as we talked about
before.
So can you explain how HRSA measures success within these
programs?
And for providers practicing in healthcare provider
shortage areas, do you have long-term data on how many of those
providers stay within the communities in which they are
practicing, or practice in other healthcare provider shortage
areas?
Ms. Johnson. I thank you so much for that question, Mr.
Chairman. It is really important to us that we are tracking as
well as we can continued participation, continued practice in
the communities where we are encouraging people to serve.
So we--as a matter of practice, we know how long people are
practicing as part of their service commitment. That is part of
their contract with us through the National Health Service
Corps. And in some instances we are able to offer people
continuations that keep them in a community longer if they
continue to have eligible medical debt.
But we also are tracking whether people stay in underserved
and rural communities. We do that most directly through our 2-
year survey tracking, which shows our rate of people continuing
to practice 2 years out from when they have completed their
service agreement--not when they start practicing in the
community, but when they have completed their service with us,
and so they are no longer under contract with us. And that
retention rate is 86 percent.
And then what we are working to do, and what we have been
doing is building the capacity to continue to monitor and be
informed by where people choose to practice beyond that. And we
are working closely with CMS on national practitioner
identifier data so that we can continue to monitor that over
time.
Mr. Guthrie. OK, thank you. And also, I know that we want
to get people out into these areas through the programs that we
just discussed, and hopefully remain in the areas. The other
way that we like to do it is in Teaching Health Center Graduate
Medical Education, if they are in those same kind of areas.
So I guess my question is how many residents practice
within the same area or community within a healthcare provider
shortage area, especially in rural communities?
Ms. Johnson. Yes----
Mr. Guthrie. So how does that get people out into the--how
does the Graduate Medical Education get people out into----
Ms. Johnson. I appreciate the question, sir. The Teaching
Health Center Graduate Medical Education program doesn't have
the same kind of service commitment tied to it that the
National Health Service Corps does.
Mr. Guthrie. Right.
Ms. Johnson. In the National Health Service Corps you get
our resources in return for practicing. And so then you are
obligated to do that. In the Teaching Health Center program,
our model is to try to make sure that we are training people in
the communities where we hope that they will continue to serve
by having people have direct experience of working in rural
areas, in underserved communities.
And we find, you know, our--after our residencies are
completed--now, you know, as Mr. Pallone mentioned, we are--we
still--we have about 1,400 people who have completed the
training. You know, more than half of them are still in their
communities. And we are continuing to work to ensure that we
are doing everything we can to keep people in rural and
underserved communities.
Mr. Guthrie. So how would you define the success of those
programs?
And I know that you measure, and you had 86 percent staying
for it. So I guess an anecdotal--or how would you define
success in these?
Ms. Johnson. I think that, from the strict requirements of
the law, our success is the overwhelming demand we have for
people who come to these programs, and the reports we get from
people who come to these programs that they would have made a
different choice about where they had to practice if not for
these programs giving them the support to pay down their
medical debt, to let them go to communities that are
underserved or rural, that allow them to do that work which we
all--which is our shared goal and why these programs have been
in place for so long, and we have all worked to continue to
grow them.
I think it is also an added benefit of these programs that
we see people continue to stay in those communities long after
their obligation to us, and that is part and parcel of what I
suspect the clinicians on this panel would say, which is what
we see, which is that people tend to stay in the environments
and communities where they train or where they have mentors or
where they start their practice. And so we get that benefit
from the programs as well.
Mr. Guthrie. Well, and it is important to have these
graduate medical programs outside of the bigger city, in the
rural areas, because, you know, a lot of southern States, in
particular, like Alabama, the universities are in Tuscaloosa
and Auburn, but the teaching hospital, the medical center's in
Birmingham and Mississippi, the same way Oxford is where their
main school--and Starkville, which are small towns. And then
there are medical centers in Jackson, Tennessee, Memphis
versus--Knoxville is not a small town, but it is important.
And I am going to close, because--and without responding,
because I am out of time. But it is important that we get
outside of those major health centers and get people in the
community so they will hopefully put down their--as we talked
the other day, their--you are graduating from medical school
and residency, you are almost at the time you are putting down
roots and picking where you are going to be.
Ms. Johnson. That is right.
Mr. Guthrie. And it is a good opportunity to be exposed to
rural areas if they haven't before. So thanks for that. I
appreciate that.
I now recognize the ranking member of the subcommittee, Ms.
Eshoo, for 5 minutes for questions.
Ms. Eshoo. Thank you, Mr. Chairman.
In 1997 this subcommittee held a joint hearing with the
Senate Labor Committee to review our Nation's system for organ
transplant. I was at that hearing, and I have long remembered
it and how the witnesses from the United Network for Organ
Sharing seemed to resent any questions being asked of them.
That is what stands out to me from that hearing, amongst other
things. But I recall that very well.
Now, 26 years later, that organization continues to have a
stranglehold on the Organ Procurement and Transplantation
Network, OPTN, which has been plagued by inefficiencies,
oversights, and errors along the way.
I know a key part of your plan to modernize the transplant
system is to establish a competitive and open bidding process
for the next OPTN contract. Why don't you tell us, in your
words, why you think this is necessary?
Ms. Johnson. Well, thank you so much for the question,
Ranking Member.
You know, if you are an individual, or your family member
is in need of an organ transplant, this is the absolute most
critical system that you depend on to make sure that the system
is fair and treats everyone the same and gives everyone equal
access, and that it is run well. And my responsibility in this
seat is that it is run well.
And as you point out, there has been--you know, the statute
is 40 years old, and there have been limited opportunities,
limited work in the past to modernize that, which is why we are
so excited to work with the subcommittee on modernizing the
system.
We think that we need best-in-class contractors rather than
having all functions of the Organ Procurement and Transplant
Network tied up in one single competitive bid. We think there
is the opportunity for competition here, which will allow----
Ms. Eshoo. Let me ask you--because I only have 2 minutes
and 43 seconds left--in fiscal year 2024, the budget proposal,
the President requested congressional authority to update tools
governing the OPTN. Do you think that the legislation that we
are considering today fulfills this request?
Ms. Johnson. I think we are continuing to provide TA to the
committee on the particulars of the legislation.
Ms. Eshoo. OK.
Ms. Johnson. But we are very pleased to be able to work
with you on this----
Ms. Eshoo. Good.
Ms. Johnson [continuing]. Going forward.
Ms. Eshoo. Great. When the Community Health Center Fund
lapsed for 5 months in 2017, how were the community centers,
health centers, impacted, and what would happen, very
importantly, if this Congress allowed the Community Health
Centers authorization to lapse again?
Ms. Johnson. Yes, thank you for the question. I mean,
nothing is more important, particularly at this moment in
healthcare delivery, than predictability and stability of
funding, particularly as healthcare facilities are trying to
recruit new workers, trying to hold on to their current
workforce.
You know, workforce is a big challenge in the field right
now----
Ms. Eshoo. It is.
Ms. Johnson [continuing]. And instability in funding, or
fear of not being able to maintain their capacity, it not only
creates disruption in their day-to-day services, but it really
creates challenges with stability of the healthcare workforce.
And everybody is competing for their workforce.
Ms. Eshoo. OK. As of April 1st, certain States have begun
removing Medicaid recipients who are no longer eligible for the
program, and more than 40 States will begin this process in the
coming months. How are the Community Health Centers preparing
for this change?
Ms. Johnson. Oh, thank you for raising this question. This
is an incredibly important moment for the people that health
centers serve, and it is important that we ensure that people
who remain eligible get redetermined and maintain their
Medicaid eligibility. Those who aren't can get to affordable
marketplace coverage. And we are using our sisters at health
centers to be able to do that. We are providing a little bit of
extra funding to our State primary care offices to coordinate
that.
But if people who otherwise would be eligible lose
coverage, health centers will still need to see them, which
puts an even greater burden on health centers at a time when we
have the--we are approaching this issue with respect to
continuing funding.
Ms. Eshoo. Terrific. Thank you for your leadership.
And I would like to point out that our former chairman of
this committee, Congressman Greg Walden, is here.
It is great to see you, Greg. You can come and sit behind
me, if you would like.
[Laughter.]
Ms. Eshoo. It is wonderful to see you, a friend to all of
us, really great to see you.
I yield back, Mr. Chairman.
Mr. Guthrie. The gentlelady yields back.
He would like to sit behind you, but he couldn't admire his
picture from sitting there.
[Laughter.]
Mr. Guthrie. Or portrait, I should say, not a picture.
The Chair now recognizes Dr. Burgess from Texas for 5
minutes for questions.
Mr. Burgess. Thank you, Mr. Chairman.
Good to see you again, Mr. Chairman. Always welcome in this
hearing room.
I do have a number of questions, Ms. Johnson, on the 340B
program. I may run out of time, and I may need to submit those
for the record.
I do need to ask--the Sickle Cell Disease Partnership had
asked that their statement for the record--be made part of the
record, and I would ask unanimous consent to----
Mr. Guthrie. Seeing no objection, so ordered.
[The information appears at the conclusion of the hearing.]
Mr. Burgess. So, of course, I do get to meet with doctors
all across the country. They come in and they talk to me about
all kinds of issues. And you can imagine after the physicians
fee schedule and reimbursement--the number 1 issue--the number
2 issue is always workforce.
So we have just been through this bad pandemic, put a lot
of stress on our healthcare system, a lot of stress on our
doctors. Now we have got inflation that has reared its ugly
head, in combination with low reimbursement. And the
consequence of that is doctors are leaving practice.
Last Congress--and I can't believe I am going to say this
out loud, but last Congress Mr. Sarbanes had a very good idea
about physician reentry. I don't know if he is going to
reintroduce the bill this year. We were never quite able to get
to a place where we could actually partner on the bill. But the
concept is one that I think is worthy of some discussion: to
create a training program for--in his version it was for
primary care doctors who would like to return to clinical
practice--to unretire, if you will.
So there is no question about it, we are at a time in this
Congress we have got to be so diligent with all our spending.
But would something like a physician reentry program work if
Federal dollars were used strictly for offsetting the costs of
training and recredentialing reentering physicians?
Ms. Johnson. Well, thank you for the question, sir, and for
your attention to this really important issue. I would love to
talk to you about the particulars of it, but conceptually, you
know, getting physicians who have the ability or the capacity
to come back into the workforce is a great goal that I would
love to work with you on, and love to think about how we can
work together to achieve that. I think that is true of nurses,
it is true of the workforce writ large.
And, you know, I recruited physicians to come to work in
the Federal Government for some time, and I see them having to
make choices about what credentials they retain. And I think it
is really important for us to think about how to make sure we
get people back into the workforce when they are able to.
Mr. Burgess. Sure. After you have left the bedside, it
can--for any number of years or months, it can be very
difficult to then reemerge on that path.
Do you--I assume that one of your principal tasks is
assuming--assembling data information available on the
effectiveness of the current healthcare workforce programs.
Ms. Johnson. That is right. We collect a lot of data on
both the--who participates and the outcomes associated with it.
Mr. Burgess. So would it be possible to consolidate or
reimagine some of these programs to be more effective with
Federal spending? Broad question, I get it, but could you do a
better job?
Ms. Johnson. Well, sir, we are constantly looking at the
programs, both for--from a couple of ways: (1) from the front
end, to make sure everyone who can be competitive is
competitive, because sometimes it is hard to apply for Federal
grants, and we are trying to make our entry door easier; (2)
from ensuring that we are getting the best outcome data and we
are not having people collect data for data's sake; and then
(3) constantly looking at where can we get efficiencies in the
design and implementation of our programs.
Mr. Burgess. So recently, Optum disclosed they employ
70,000 physicians, 7 percent of the total workforce. They
acquire new health systems, literally, every month. And they
want to add 10,000 physicians a year to their growing base.
Does HRSA collect data on whether the National Health
Service Corps physicians--or any physicians, for that matter--
stay independent, or do they join these large practices?
Ms. Johnson. We collect data on our National Health Service
Corps members when they are fulfilling their service
obligation, and then we do our 2-year outlook. And we are
continually working to build to figure out where they are going
in--beyond that. And so, you know, we, obviously, are looking
for where they are billing from in the future.
Mr. Burgess. Sure. Well, I mean, it leads up to--one of my
pet peeves is--in this country, because of the Affordable Care
Act, it is legal for hospitals and health systems to own
doctors, but doctors can't own hospitals, and we are in the
best position to understand the allocation of those resources.
I hope this committee will work on the concept of physician
ownership of hospitals. It is one that remains, I--should
remain at the forefront of our minds.
And Mr. Chairman, I yield back.
Mr. Guthrie. The gentleman yields back. The Chair now
recognizes Mr. Sarbanes from Maryland for 5 minutes for
questions.
Mr. Sarbanes. Thanks very much, Mr. Chairman, and let me
thank our witness today for your good work. It is so important.
And let me thank Rep. Burgess, as well, for saying such
kind things a moment ago--apparently, against all of his
impulses. But I appreciate that.
[Laughter.]
Mr. Sarbanes. And I look forward to continuing to work on
the Physician Reentry Initiative. And I appreciate the
conversations that we have been having over the last couple of
years about--or really, I guess, over the last 6 months. I
think there is good opportunity there to collaborate and think
about an innovative design that can encourage that cohort to
come back into the practice of medicine, particularly in those
areas of shortage.
And we would certainly look forward to input from you, Ms.
Johnson, about how that can be designed, and what sort of
resources could be brought to bear to assist with this, because
we understand--and you certainly understand--that the shortages
across the country in just about every category of the health
workforce, if not, frankly, every category of the entire
workforce in the country, those shortages are significant and
need to be addressed. And I thank you for all of the work that
you are doing.
I do also want to commend my colleague, Representative
Blunt Rochester, for the work that she has been doing. And we
have been collaborating on this, as well, in terms of
advocating for funding for HRSA's efforts to collect and
analyze, disseminate information about healthcare workforce
dynamics through the National Center on Health Workforce
Analysis, which is a very important resource for your agency
and, frankly, for the country in terms of understanding what
these dynamics are and making sure we are, again, being
creative in addressing them. We need to enact policies that
will lead to a stronger, more diverse workforce, one that can
address the current and projected provider shortages that we
face.
In addition, there is the National Nursing Workforce Center
Act, which is another bill that Representative Blunt Rochester
has been working on. And I again thank her for those efforts.
It will be interesting to understand a little bit better what
you envision the design of that could be, if you get authority
around it.
I know that the Biden administration has made clear,
including through its proposed Health Care Workforce Innovation
Program, that it definitely understands the need to
comprehensively and innovatively approach healthcare workforce
issues, particularly now. And there is, I think, bipartisan
focus on this as we continue to confront a mental and
behavioral healthcare crisis that seems to be growing by the
day and as we are serving an aging population. So these
innovative approaches have to span provider types, geographics,
and other things in order to be effective. And no solution is
too small to make a difference.
I do know, as well, that there's workforce programs that
provide educational, other financial assistance. You have
mentioned that in terms of the Corps and this idea of
exchanging for service, that support in exchange for service at
the Community Health Centers and other critical access points.
Can you speak just briefly--I have about a minute left, but
I would be interested to hear you speak again or emphasize what
it would mean to increase our commitments to the National
Health Services Core, other service-based programs like a kind
of reentry program that was mentioned earlier by Congressman
Burgess, but these efforts to help us recruit, train, retain a
diverse and community-focused--and I think this is very
important--workforce that can meet our current and projected
demand.
Ms. Johnson. Thank you so much for the question,
Congressman.
There is--I suspect this is true for your experience as
well--there is nowhere that I go, to any of our grantees, to
anyone in the community-based health workforce, where workforce
isn't the first, second, and third list on their priorities of
the issues that they are facing right now, which is why we
think it is so critically important to sustain the level that
we are at when it comes to what we have been able to do with
the National Health Service Corps and be able to help place
clinicians in the communities that need them most in return for
loan repayments and scholarships, that that service commitment
is so critical.
We also think--outside the scope of the hearing today, but
we also think the other investments we are making in our
budget, as you pointed to, our new innovation program that
would help--really help bubble up good, community-based ideas
for how we more effectively train and more efficiently train in
the healthcare workforce is a vital pillar of how we kind of
move the process forward. Our new investments in training more
mental health providers, our new investments in breaking some
of the bottlenecks that make it harder to move more people into
nurse training, we really think that, comprehensively, the
budget is focused on workforce as a priority.
Mr. Sarbanes. Thank you very much.
I yield back, Mr. Chairman. I appreciate it.
Mr. Guthrie. Thank you. The gentleman yields back. The
Chair now recognizes Chairwoman McMorris Rodgers for 5 minutes
for questions.
Mrs. Rodgers. Thank you, Mr. Chairman.
In a report published in December of 2015, GAO reported
that HHS has 72 workforce programs that were funded in fiscal
year 2014. In that report, GAO looked at the 12 programs with
the highest obligations. Seven of those were at HRSA, including
the National Health Service Corps.
How many workforce programs does HRSA currently administer?
Ms. Johnson. I believe our workforce number now is about
50.
Mrs. Rodgers. OK. Well, how many----
Ms. Johnson. And that is considered the individual----
Mrs. Rodgers [continuing]. Workforce programs----
Ms. Johnson [continuing]. Programs.
Mrs. Rodgers. So 50 different workforce programs?
Ms. Johnson. Different funding opportunities.
Mrs. Rodgers. OK. And then would you speak to how you
measure performance outcomes of these programs?
Ms. Johnson. Yes. Thank you for the question.
Performance outcomes is a weighted factor in awarding our
grants. We make sure that we are collecting outcomes associated
with the grant. That will factor into future funding for the
potential awardee, it factors into decisions about the current
award, and then we collect performance metrics in detail about
the participants in the program and the outcomes associated
with the programs.
Mrs. Rodgers. OK. Would--could you provide the committee
with an updated list of the programs, including basic funding
and performance----
Ms. Johnson. Absolutely.
Mrs. Rodgers. OK, thank you. As I mentioned in my opening
statement, I have been a long-time supporter of the Teaching
Health Center GME program. I have led its authorization--
reauthorization, not authorization--reauthorization of the
program during several Congresses. And I understand HRSA plans
to use resources from the American Rescue Plan to expand to new
residency programs.
How will this impact existing Teaching Health Centers like
the Spokane Teaching Health Center in my district?
Ms. Johnson. Thank you so much for the question, and thank
you for your leadership on this issue, Madam Chairwoman. It has
been incredibly helpful to have the impact of your vision here,
and what it means for residents on the ground, and so inspiring
to hear the residents we talked to in Spokane about how they
intend to continue to work in rural communities.
The President's budget is actually built so that we can
both take advantage of resources that we have had from the
American Rescue Plan to help new planning, new--there is a lot
of interest in the health center program, the Teaching Health
Center program, and so to help new folks plan and develop and
get ready to potentially apply in the future.
But our budget is built to fund current awardees and then,
over time, be able to bring on new folks if they meet the
accreditation thresholds going forward and they are
competitive.
Mrs. Rodgers. OK. In 2019 GAO reported that between 2010
and 2017 Community Health Centers saw an increase in revenue
coming from insurance, both public and private pay. How has
health centers' revenue changed since 2017?
Ms. Johnson. I can't speak to the details, but I can tell
you that what has happened is that health centers have
continued to be the resource in communities for people who are
underserved and/or underinsured. And so across the country in
communities, whether they have expanded Medicaid or not, health
centers are still the resource that is seeing people who have--
who lack health insurance or who have Medicaid and don't have
another usual source of care.
Mrs. Rodgers. So does HRSA anticipate any further changes
to the public and private revenue sources the health centers
receive?
Ms. Johnson. I think what we--the one thing that we did see
was some growth in people--a small growth, but people who got
marketplace coverage who had previously been uninsured may
continue to see their health center provider for the continuity
of care.
Mrs. Rodgers. OK, OK, thanks. As a mom with a son with Down
syndrome, I am extremely concerned by the continued reports of
individuals with disabilities being denied an organ transplant
solely based upon an individual's disability. As the agency
tasked with administering the Organ Procurement and
Transplantation Network, or OPTN, what steps has HRSA taken to
address discrimination against individuals with disabilities in
the organ transplant system?
Ms. Johnson. Thank you so much for the question. We are
laser-focused on reforming the system so that we have better
accountability and better transparency and oversight in the
OPTN system. And part of that is about bringing more
competition into the program so that the structures, the
functions that govern our IT and our policy and our
governance--right now, the--our vendor, the Organ Procurement
and Transplant Network, and the private corporation that runs
outreach and the like is the same vendor. And we think that we
need to separate the boards, have more accountability in the
board, and that that will be a venue for us getting better
fairness and equity across the system.
Mrs. Rodgers. OK. Well, I appreciate hearing more about
those additional steps that you are taking----
Ms. Johnson. Absolutely.
Mrs. Rodgers [continuing]. At HRSA, and thanks for being
here today.
Ms. Johnson. Absolutely.
Mrs. Rodgers. I yield back.
Mr. Guthrie. I thank--the Chair yields back. The Chair now
recognizes the ranking member of the full committee for 5
minutes for questions.
Mr. Pallone. Thank you, Chairman Guthrie. I appreciate the
opportunity to discuss these important programs today, and
thank you and Administrator Johnson for being here today. And I
also thank the Administrator for coming to my Community Health
Center in Red Bank recently. I really appreciate you doing
that.
However, before I discuss primary care I must note that I
remain very concerned by the recent efforts of extremist
Federal judges putting their beliefs between doctors and their
patients, particularly with regard to the abortion pill
mifepristone. If we are to have a full discussion on ways to
grow our healthcare workforce and protect patients, we must
start with ensuring that healthcare providers can provide the
care their patients need and prescribe the medications that
have been proven safe and effective. And I hope my majority
colleagues recognize how detrimental these recent court actions
like the FDA v, Alliance for Hippocratic Medicine could be, not
only for patients but also for providers.
So let me ask Administrator Johnson about this.
From your perspective, what impact do you think these
decisions like this recent one in FDA v, Alliance for
Hippocratic Medicine by what I consider extremist judges have
on the healthcare workforce in this country?
Ms. Johnson. Well, thank you for the question, Ranking
Member. Obviously, we are--there is actually--there is,
obviously, ongoing litigation, so I won't speak to the
particulars of that. But I will say, you know, in healthcare
services for a very long time we have recognized the value and
the importance of the relationship between the provider and the
patient, and respecting decisions that happen between the
provider and the patient. And that is what our policies and our
training programs are organized around, and that is what is
important, is making sure that the--that we are centered on the
patient and the provider.
Mr. Pallone. Well, let me ask--well, I guess Chair Rodgers
isn't here. Let me ask Chair Guthrie.
Every Democratic member of the committee sent you and Chair
Rodgers a letter last week requesting that you immediately hold
a hearing on the impact of this case. And I think we have to
hear from experts on how detrimental this case could be for
women and for all the Americans who rely on FDA-approved drugs.
Even the pharmaceutical industry agrees that this case has
dangerous precedent-setting implications. I haven't received a
response.
So if you could, tell me, Chair Guthrie, whether you will
hold a hearing on this important issue.
Mr. Guthrie. Well, we are going to continue to do oversight
over the FDA, so we will have that under our committee's
jurisdiction.
Mr. Pallone. Well----
Mr. Guthrie. We will continue to do oversight.
Mr. Pallone. Do you know when that is likely to be?
Mr. Guthrie. I don't have a time for it.
Mr. Pallone. Yes. I mean, the problem is, you know, that
today--I don't know if anything happened this morning yet, but
as of, I think, midnight tonight the stay of the lower court's
decision could be lifted, unless the Supreme Court acts. And
that would mean that this pill would not be available, for the
most part, in the country. And so I really think we need to do
something immediately. And I just want to reiterate that again.
We should have the hearing as soon as possible.
But I wanted to--I do want to see if--I know I only have a
little time left. I want to ask Administrator Johnson about the
primary care workforce. And, you know, many people in this
country struggle to access primary care because of a lack of
providers. We have already discussed this. There was a report
from the Kaiser Family Foundation that said over 97 million
Americans live in a designated primary care health professional
shortage area. And of course, the Teaching Health Center
Graduate Medical Education Program is designed to address that.
So let me ask you a question: Can you explain the value of
medical residence training in community-based settings rather
than in hospitals, and what kind of impact the program, like
the Teaching Health Center Graduate Medical program, has,
particularly in underserved communities?
You have got about a minute.
Ms. Johnson. Well, I will just say that we are so excited
about the way this innovative program has sort of changed the
game for what primary care training can and should look like
and anchoring it in the community in the places where we want
primary care providers to serve. It makes it more likely that
they will practice there, it gives them the kind of experience
and access to the kind of training experiences that will then
be useful to them in their primary care practice. And so it has
been transformational, and it makes a huge difference in
communities across the country.
Mr. Pallone. And just the challenges, particularly because
of unstable funding--you know, we have had this discussion
about how, if you do this short-term and the funding is not
there, it really presents challenges for the program. If you
could, respond quickly.
Ms. Johnson. It has been very difficult for programs to
plan appropriately. Funding cliffs make it hard to know whether
with security you can recruit your next class of residents. It
makes it hard for residents who really want to train in the
community to make that commitment if they are not sure the
funding is there. So it creates problems, challenges for
programs, existing residents, and future residents.
Mr. Pallone. Thank you so much. I appreciate everything you
have been doing on this.
And thank you, Chairman.
Mr. Guthrie. Thank you. The ranking member yields back. The
Chair now recognizes Mr. Griffith for 5 minutes for questions.
Mr. Griffith. So I have lots of questions about the Black
Lung Program. But unfortunately, all the questions I have are
in areas that are not under your jurisdiction, so I will have
to save those for somebody else.
Ms. Johnson. OK.
Mr. Griffith. But there are a lot of things I think we can
do to help black lung victims as we move forward. So if I can
ever be of help to you on that, let me know.
Ms. Johnson. I very much appreciate that, and we will do
all we can with our--from our vantage point as well.
Mr. Griffith. Thank you. So let's talk 340B. Some of the
nonprofit hospital systems, in my opinion, have been exploiting
the 340B program to reap huge profits that fuel expansion into
affluent communities instead of continued reinvestment in
communities of greatest need. In fact, my district is
relatively economically stressed. We are 409th out of 435 for
median household pay. So I have got for-profit hospitals that
are doing a substantial amount, and my hospitals in my area
that get 340B are using it--through my analysis, at least--they
are using it to help people. They don't have much choice,
frankly. So it is a great program, and I support it.
That being said, there are bad actors out there. And one
notable example happened in Virginia in what was then the
district of my friend, Don McEachin. And it appears that Bon
Secours Hospital System used the Richmond Community Hospital,
which is clearly 340B-eligible, to expand its use of 340B at
the expense of Richmond Community Hospital and their patients
in that economically stressed community. Over the years,
services at the Richmond Community Hospital were cut and
departments closed, while at the same time Bon Secours, it
appears, was transferring millions out of the Richmond Hospital
to other hospitals within the system--some in their system
maybe even as far away as Ohio, I am told.
So this is important to me. How do we make these--how do we
make reforms? What exactly do you plan to do with the
information that you all are collecting? I know you have sent a
number of letters out to hospitals asking them how they are
using it. What do you plan to do with that information when you
get it? And if you don't get it, should we be passing
legislation?
I know I am adding two or three things in there. Should we
be passing legislation for more transparency?
Because I made a promise to Don that I wouldn't let this
go, and neither one of us knew he was going to pass away. He
called me a couple of weeks before his death and said, ``Hey,
as chairman of Oversight and Investigations on Energy and
Commerce, I need your help.'' I promised him I would help. Help
me keep my promise.
Ms. Johnson. Well, thank you so much for raising this
issue. Thank you for your work on this issue.
I had the opportunity to talk to him before he passed as
well, on this topic, and know how passionate he was about
making sure resources are going to the places where they are
intended.
As you noted, 340B plays a vital role for some critical
safety net providers, but we need to make sure that there is
accountability and transparency in the system. Our recent
letters to a number of covered entities were part of that
process. Our request in the President's budget that we actually
get specific designated authority for reporting--for covered
entities report--to report on the savings from the program, and
how that is benefiting the communities they serve is a specific
ask we have made in the budget.
We look forward to working with you on that. We really
would benefit from your assistance in making sure that we have
all the tools necessary. As you probably know, we are in a lot
of litigation on 340B, and so clarity about our scope and
authority would be incredibly important to us.
Mr. Griffith. All right, and I look forward to working with
you on that.
Let's switch gears and go to Community Health Centers,
another group that does great work in my region. I am glad to
have them.
But it has come to my attention in talking with some of my
Community Health Centers that pharmacy benefit managers are
taking predatory actions against the health centers by
effectively forcing them to sign what they believe to be unfair
contracts. They are forced to sign these contracts, which
include provisions which give the savings, or a part of the
savings, back to the PBM, the pharmacy benefit manager, instead
of helping the poor folks who really need these services of the
health centers.
So do you all have legal authority to address the matter,
or is this an issue that we need to--Mr. Carter and I need to
put legislation in on?
Ms. Johnson. I would ask----
Mr. Griffith. Oh, I should have--shouldn't have left out
Mrs. Harshbarger.
Ms. Johnson. Thank you. I would ask for your assistance
here.
We--as you may know, we also have had the issue of
manufacturers not selling to covered entities via their
contract pharmacy arrangements. We issued violation letters
associated with that. That has been a source of considerable
litigation, as well. Clarity about our authority and scope here
to be able to--because I share your view that accountability in
this system is critical and would love to work with you on
that.
Mr. Griffith. All right. I look forward to working with
you. And if we need legislation, you have got three people on
this committee that are more than happy to help you in any way
you need.
Ms. Johnson. Thank you.
Mr. Griffith. I yield back, Mr. Chairman.
Mr. Guthrie. Thank you. The Chair yields back, and the
Chair now recognizes Mr. Cardenas from California for 5 minutes
for questions.
Mr. Cardenas. Thank you very much, Chairman Guthrie, and
also Ranking Member Eshoo, for holding this very important
hearing.
And thank you, Administrator Johnson, for coming forward. I
like your answers. Your answers are very concise. You are not
copying what they do in the Senate, which is filibustering.
Sometimes some of our witnesses kind of do that. But thank you
for being so direct with your answers and so helpful.
I am concerned about shortages in pediatric care. We need
to look no further than this past winter, when a combination of
COVID, RSV, and flu wreaked havoc on our kids and left many
without access to care.
Administrator Johnson, what role will increased funding for
the THC GME program play in boosting the pediatric care
workforce?
And how can the program increasingly prioritize physicians
who will work in medically underserved communities?
Ms. Johnson. Thank you so much for the question,
Congressman.
The Teaching Health Center Graduate Medical Education
program, because it is so primary-care-focused, we have worked
really hard to encourage programs to stand up pediatric
programs. We have a few. We hope, with our planning and
development grants, we will get more. We have trained probably
close to 50 pediatricians through the program so far. We hope
to continue to grow that and--as we go forward, to ensure that
this vital program is actually doing what we want in terms of
training not only internal medicine and family medicine docs,
but family--but pediatricians in community-based settings.
Mr. Cardenas. Thank you. And also I want to take a moment
to discuss the critical role that Community Health Centers
play.
Personally, I grew up in a household of 11 children and 2
parents. And for a good portion of my childhood we did not have
health coverage. We didn't have access to healthcare. Honestly,
it came down to prayers and aspirin, which are--which was the
way that we handled things most of the time. And the place
where we showed up, unfortunately, was the emergency room. And
that still goes on to this day with too many families, whether
it is one child or many children. And that--we need to do what
we can in this great country to make sure that that is not the
alternative, it is either no coverage or going to the emergency
room.
CHCs and FQHCs, literally, are a lifeline for families
with--like mine. For example, FQHCs, when I was about 10 years
old, were created, and one of them showed up in my community,
and that is when we finally got access to healthcare. So they
are the reason why I received care when I was 10 years old and
beyond.
NAVHC was the place that we went, and other CHCs are still
doing this essential work in my district to this day, and they
are getting creative about caring for as many people as
possible. For example, some are using mobile clinics to provide
care to hard-to-reach populations. Also, in many cases, centers
are even keeping extended hours to try to keep ERs, you know,
out of the picture as much as possible. I am proud of the work
that the CHCs do in my community, and so many questions are
really focused on how to grow these lifesaving resources.
So, Administrator Johnson, what else can we do from a
policy standpoint to increase the reach of CHCs, especially in
medically underserved and rural communities?
Ms. Johnson. Oh, thank you so much for the question,
because that is what our budget is about. Our budget is saying
we not only need to sustain where we are, but this is a proven
model and we know it works, so we need to ensure that we are
building on it to get to more people in need. And so our budget
focuses on new access points.
We know from all the health centers--as you said, when a
health center shows up in your community it makes a difference
for families. So getting more health centers into more
communities, extended hours, making sure--you know, if you work
shift work, getting to a regular office hour appointment is
hard. Health centers try really hard now, but we want to invest
in making sure that they have extended hours.
And integrating mental health and substance use disorder
services into the core of what health centers do, so that
primary care isn't, you know, medical services on one side and
then refer you to mental health and substance use disorder, but
primary care is integrated care.
Mr. Cardenas. When--one of the big issues is workforce
recruitment. And how will this--how will funding help ensure
that CHCs are adequately staffed?
Ms. Johnson. Yes, the funding--the continuation and
expansion of our health center resources are absolutely vital
to them retaining their health workforce and growing their
health workforce. And uncertainty about the future of their
funding will make it challenging when it comes to retaining
workforce at a time like this, when the workforce competition
is so intense in the healthcare field.
Mr. Cardenas. Well, thank you.
My time is about expired. Thank you, Mr. Chairman. I yield
back.
Mr. Guthrie. Thank you. The gentleman yields back. The
Chair now calls on Mr.--recognizes Mr. Bilirakis for 5 minutes
for questions.
Mr. Bilirakis. Thank you, Mr. Chairman, I appreciate it.
Again, thanks. This is a very important conversation today, as
you know. And we are looking at multiple reauthorizations that
provide such vital care and services for many of my
constituents, for Floridians and all Americans.
My question is--and I appreciate you being here, thank you.
To start, I am very thankful that legislation I am working on
to extend the funding for the Special Diabetes Program and the
Special Diabetes Program for Indians has been noticed at this
hearing.
I appreciate it, Mr. Chairman. Working with my friends Ms.
DeGette, Mr. Cole, and Dr. Ruiz, we have introduced bills that
would provide a level of funding for these programs for 5 more
years. These programs are vitally important, as you know, an
essential resource in our Nation's investment in diabetes
research, treatment, education, and prevention programs.
Diabetes is our country's most expensive chronic disease in
both human and economic terms, affecting people of all ages,
races, and in every region of our country. It is the leading
cause of heart disease and stroke. Additionally, it is the
number 1 cause of kidney disease blindness in working-age
adults and lower limb amputations, unfortunately. Reauthorizing
these programs will provide stability and hope for the millions
of Americans impacted by diabetes. This is truly a bipartisan
effort, and I look forward to working with all my colleagues to
get these programs extended long-term.
Ms. Johnson, thank you again for being here. You have not
mentioned diabetes in your testimony today, but I am sure you
recognize its impact on the American people. I know that. What
role do you believe the primary care workforce plays in
addressing prediabetes and diabetes in the U.S. in general,
please?
Ms. Johnson. Thank you so much, Congressman, for your
comments. And I do defer to my colleagues in the other agencies
who run the Special Diabetes Program but know from the long
history of those programs how valuable they are to the public
health and healthcare services.
Diabetes is a--it is such a--it, in and of itself, is such
a challenging chronic disease for people to manage. And the
risk factors for it are just as challenging. And having an
established relationship with a community health provider who
often speaks your language or is from your community makes such
a difference in identifying risk early, in doing the kind of
modifications and work necessary to try to forestall the onset
of diabetes, to try to help people manage their condition if
they have diabetes. It just makes such a difference to have a
usual source of care.
And when you are uninsured or underinsured, having a usual
source of care is very hard unless you can turn to a Community
Health Center that will see you regardless of your ability to
pay. And those Community Health Centers are often staffed by
National Health Service Corps members. So all of this works
together to make sure that we have that critical work.
I would also say we run a lot of maternal and child health
programs as we work on maternal mortality crises and infant
mortality issues. Addressing diabetes is such an important part
of that equation as well.
Mr. Bilirakis. Thank you very much. The next question,
because I still have some time, another very important program
we must reauthorize, of course, is the Community Health Center
Fund. I have been an outspoken advocate for the role that
Community Health Centers play in providing whole healthcare for
so many Americans, and I am proud to have led efforts to
reauthorize the Community Health Center programs in the past
years. I am very grateful to join forces with Dr. Joyce, and I
thank him for his leadership on this particular bill.
Locally, I am also very proud of the work that Florida
Community Health Centers are doing throughout my home State.
One CHC, Suncoast Community Health Center, has developed and
built its own subsidiary training academy, Suncoast Academy,
that provides training for dental assistants, pharmacy
technicians, and later this year, medical assistants. It is
really fantastic. Several CHCs around the State have begun
planning or have already implemented registered apprenticeships
without--within their organizations.
So a question for you, Ms. Johnson--and again, I know that
Florida CHCs are extremely resourceful--and I am sure they are
around the country as well, it is a great program--and have
found creative ways to increase access for patients. You have
touched on this. They have a true sense of understanding of the
needs of our neighborhoods and communities. How do you intend
to partner with State CHCs to support and leverage the
strength--the strengths, as well as their efforts to grow the
workforce and expand services? If you could elaborate on that--
I know you touched on it--I would appreciate it.
Ms. Johnson. Yes, thank you. Thank you so much for the
question.
I mean, one of the things that I am really excited about in
the President's budget this year is a new initiative that we
have proposed on the discretionary side called our Health Care
Workforce Innovation Program, which would be our way to sort
of--in many ways, our healthcare workforce programs are defined
by statute, and we lay out what the requirements are. Here we
are really trying to get the best ideas from the field, like
the models that Florida's health centers are implementing, and
figure out what works and what we can start taking to scale so
that we can actually be seeding some of these initiatives as
well. Because we hear time and time again med techs, farm
techs, like a lot of the support, the critical folks who are
early in the career ladder----
Mr. Guthrie. Yes, thanks. We are going to have to round up
this series of questions and----
Mr. Bilirakis. Yes, yes, I yield back.
Mr. Guthrie [continuing]. Time has expired, and I thank you
for that, your answer. I know we are going to get to more of
that as we--as you continue to talk, so--but the Chair now
recognizes Dr. Ruiz from California for 5 minutes for
questions.
Mr. Ruiz. Thank you, and thank you for holding this
important hearing today.
I have been a long-time advocate for the Teaching Health
Center program and have introduced bills to extend the
authorization time and as well as increasing funding because I
believe in its mission, and I believe that it works.
I grew up, practiced medicine, and now represent an area
that is in desperate need of healthcare providers. The doctor
shortage is a nationwide problem, both in absolute terms and
also in the distribution of physicians, but more acute in some
communities like those in my district, where in research that I
did back in 2010, there was 1 full-time equivalent physician
per 9,000 people. And as you know, the medically underserved
criteria is 1 to 3,000.
So, as you know, where a doctor is from and where they
train are the two biggest indicators of where they will
practice. So training physicians in health centers that are
located in and directly serve communities in need is critical
in addressing the provider shortage. More importantly, taking
individuals from those underserved communities and training
them in their underserved communities increases the probability
that those communities will have physicians who will care about
them and take care of them.
That is why I am proud to have joined Ranking Member
Pallone to introduce the Doctors of Community Act, which will
permanently fund the Teaching Health Centers program and result
in the largest expansion of the program since its creation.
Administrator Johnson, is there a demand for this program on
the physician side, meaning do Teaching Health Centers receive
a significant number of applications for residency slots, or
are they struggling to get residents to apply?
Ms. Johnson. Oh, there is demand for this program,
Congressman. There is a lot of interest both in establishing
residency programs and then in recruiting residents themselves
to the programs. There is a lot of interest and a lot of
enthusiasm. I think people who have a dedication to a
community-based service, who want to practice in high-need
communities or rural areas are drawn to this program.
What is challenging both for programs and for the
recruitment of residents is if there is instability in the
program funding or not--or folks not having confidence that it
will be there for them through the full term of their
residency.
Mr. Ruiz. And what do you see in terms of outcomes for this
program? What is the percentage of physicians that stay in the
communities that they train in?
Ms. Johnson. Well over half of them stay in the community--
in communities or in underserved communities. But we continue
to see that number increasing, and we know that people are
interested in making sure that--we know that the data all
supports that people who train in the community are more likely
to stay in the community.
Mr. Ruiz. So jumping topics to address another one of my
policy priorities, in this hearing we are considering H.R.
2547, the Special Diabetes Program for Indians Reauthorization
Act of 2023, which I introduced with Congressman Cole. Although
these programs do not fall squarely within HRSA's jurisdiction,
the resources provided by the SDPI program have significantly--
impacts in the communities that HRSA serves and the health
workforce that provides diabetes care.
And as a doctor, time and time again I saw patients in the
emergency department with preventable conditions related to
their diabetes, the silent killer. And these problem--this
problem is continuing to get worse, particularly in communities
of color with low access to healthcare prevention and chronic
care for their chronic illness. And data shows that the
incidence of type 1 diabetes is increasing among all
population. Nevertheless, American Indian and Alaska Native
populations have the highest prevalence of diabetes, which
leads to renal failure, neuropathies, amputations, blindness,
and other chronic comorbidities.
I believe that reauthorizing this program is critical to
reducing the incidence and mortality of diabetes, which overall
is the seventh leading cause of death and the number 1 cause of
kidney failure and lower limb amputations and adult blindness.
What actions is HRSA taking to address the growing
incidence of diabetes, and how is HRSA coordinating with other
agencies such as the Indian Health Service to serve communities
acutely affected by diabetes?
Ms. Johnson. There is no doubt how critical the Special
Diabetes Programs are to both the work that they do directly,
but then also building the models that our primary care
providers can learn from and implement. And that is what we do,
is create learning environments and learning collaboratives
across health centers so that we are sharing the best practices
and knowledge so that we are able to help do the cutting-edge
prevention and treatment work.
Mr. Ruiz. Thank you. I do believe that these Teaching
Health Centers should also participate in pipeline development
programs----
Ms. Johnson. Yes.
Mr. Ruiz [continuing]. Working with local high schools in
these underserved communities, local colleges, and medical
schools so that from an early start they can start in high
school, finish in medical school in residency training, like
the Future Physician Leaders Program that I initiated back when
I was senior associate dean at UC Riverside School of Medicine.
Ms. Johnson. Terrific. We also fund on the discretionary
side some of those programs. So building those bridges is
really important to us.
Mr. Ruiz. Wonderful, thank you.
Ms. Johnson. Thank you.
Mr. Guthrie. Thank you. The gentleman yields back. The
Chair now recognizes Mr. Johnson for 5 minutes for questions.
Mr. Johnson. Well, thank you, Chairman Guthrie, and thank
you, Administrator Johnson, for making yourself available
today.
I also want to thank you for--you and HRSA--for your
response to the February 3rd train derailment in East
Palestine, a small village in my district. It is critically
important that all levels of government continue to work hard
and hand in hand to ensure the health and long-term viability
of that small village that I represent.
Locally, the Community Action Agency of Columbiana County
stepped up immediately after the East Palestine train
derailment, deploying a mobile health unit to a local church
that enabled physicians and toxicology experts to perform
health assessments for those individuals looking for care in
the aftermath of the disaster. For residents without a
physician, the health center provided quality medical and
dental care to help the community recover from the event.
So my question for you, Administrator Johnson, yours is the
primary Federal agency responsible for improving access to
healthcare for people who are uninsured, isolated, or medically
vulnerable. And I would argue that that encapsulates the
village of East Palestine. What has HRSA's involvement been
with ensuring access to those medically vulnerable citizens
there?
Ms. Johnson. Yes, thank you so much for the question and
for recognizing the resources we were able to provide soon
after the incident to ensure that the health center in the
community was able to staff and support the mobile clinic and
other resources.
We think it is vitally important that health centers are
able to surge in a response, because they have community
relationships and because they know where their patients are.
Often for some of our centers that serve individuals who are
experiencing homelessness, they have--they are the connection
to that individual and their services. So we are anxious to
continue to build on that work, and we were delighted to be
able to do that short-term. And we look forward to working with
you and with the community on response going forward.
Mr. Johnson. And what are you doing to coordinate the
efforts on the ground?
How have you assisted Community Health Centers like the
Community Action Agency on the ground to ensure that resources
are being allocated and used efficiently and effectively?
Ms. Johnson. Yes, we have a partnership with State primary
care offices, which are often the coordinating entity for
Community Health Centers across the State. In the event of an
emergency, we often work directly with the State primary care
agency----
Mr. Johnson. OK.
Ms. Johnson [continuing]. To make sure that we are touching
all of the relevant health centers in the community. And then
we work closely with our disaster response colleagues at the
Federal--at our Department and across FEMA.
Mr. Johnson. All right. Another broader challenge that many
in my district and much of rural America deal with is
workforce.
Ms. Johnson. Yes.
Mr. Johnson. Every industry, from manufacturing to
healthcare, is having trouble recruiting and maintaining a
necessary and sufficient workforce. Why is this?
I mean, it could be because Washington paid countless
individuals to stay at home and sit on the couch, or because we
don't have things like work requirements on able-bodied
Americans to receive Federal assistance. We, Washington, has
incentivized people not to go to work.
To this point, can you please explain for us today how the
Federal Office of Rural Health Policy is working with Community
Health Centers in rural communities to train and place
healthcare professionals in regions like Appalachia, where I
call home?
Ms. Johnson. Yes, sir. I would say, you know, what we are
seeing in healthcare is really--we asked a lot of the
healthcare workforce over the last several years, and it was
incredibly traumatic and stressful for a lot of people. And we
have seen some people, you know, either retire or move on to
other work because of the strain of that, which is why we have
made an investment in supporting the mental health and well-
being of the healthcare workforce. We have done awards to
medical centers across the country to help them focus on
retaining their workforce by supporting their mental health and
well-being.
Our Federal Office of Rural Health Policy focuses on
building rural residency programs so that we can train in rural
communities. It focuses on making sure we are supporting the
viability and financial viability of rural hospitals by
providing support for them directly to ensure their long-term
sustainability. We provide a ton of technical assistance in
rural communities. We are very focused on workforce in rural
communities.
Mr. Johnson. OK. Well, my fear--and something that I would
continue to sensitize you to--is that we are seeing--and we are
seeing it daily--is that these rural communities are often left
behind for--in favor of more urban areas with regards to this
program. And I appreciate it that you are sensitive to that.
We have got a long way to go to equate healthcare access
and the quality of healthcare for people in rural America.
Ms. Johnson. No doubt.
Mr. Johnson. I yield back.
Ms. Johnson. No doubt that there is a lot of work to be
done in rural America, but a lot of our National Service Corps
members are in rural communities. Thank you, sir.
Mr. Johnson. Thank you.
I yield back.
Mr. Guthrie. The gentleman yields back, and the Chair now
recognizes Ms. Kuster from New Hampshire for 5 minutes for
questions.
Ms. Kuster. Thank you very much, Mr. Chairman, I appreciate
it.
Thank you to Administrator Johnson for being with us today.
As has been highlighted throughout this important hearing, we
are at a key point for supporting Community Health Centers. In
New Hampshire, Community Health Centers serve as a critical
site of care, filling gaps in rural areas and ensuring people
of all backgrounds can access the healthcare that they need.
Cost-effective preventative care is under attack by
conservative courts across the country trying to politicize our
healthcare system. And it is essential we defend the healthcare
providers who are delivering lifesaving services.
The National Association of Community Health Centers finds
that, overall, Community Health Centers save the healthcare
system $24 billion annually by increasing access to
comprehensive, high-quality, preventative, and primary care. If
Congress does not invest in our Community Health Centers,
American health will suffer, and the cost of care will
increase.
I applaud my colleagues for introducing a bill that would
not lead to cuts in funding, but we must do more. We know that
flat funding will prevent Community Health Centers from meeting
our constituents' needs. While I am hopeful our colleagues in
the Senate will be able to raise the funding levels, the
conversation must start here.
Administrator Johnson, can you speak to the importance of
increasing funding for Community Health Centers and how
increases could benefit CHCs in States like New Hampshire?
Ms. Johnson. Thank you so much for the question. That is
very consistent with the way our budget is structured. We
recognize that it is vitally important that we sustain where we
are with health centers, but we are not meeting the needs of
communities that--to their fullest. And we have the opportunity
to do that here, in particular in a couple of key areas.
We think it is important to make sure that we are expanding
health centers into communities that need more sites. You know,
convenience and access to healthcare is critical to delivery,
as is making sure that we have expanded hours in health
centers. Again, people who work shift work or who have child
care issues, there are a host of things that can make it hard
to see a doctor during normal business hours. We can expand
business hours in health centers. We can make it more
convenient for people to get the care they need, and then they
can go to a health center instead of going to an emergency
room, which clearly costs more.
And at the same time, we think it is vitally important to
recognize the moment that we are in when it comes to the needs
of families around mental health and substance use disorder.
And time and time again when I talk to primary care providers,
they say visits that started out being about hypertension or
other issues quickly become about a mental health issue. And so
making sure that we can provide those services and provide that
support in health centers is part of what we think is essential
to meeting this moment for families' needs.
Ms. Kuster. Great. You practically took the words out of my
mouth, because I visited a site in my district just recently,
and they are embedding the mental healthcare in the healthcare
facility and vice versa, embedding mental healthcare in the--
embedding healthcare into the mental health facilities.
So Community Health Centers do play an essential role in
combating addiction and mental health. And I am the cochair of
the bipartisan Mental Health and Substance Use Disorder Task
Force, and I have seen firsthand the innovative ways that our
health centers are helping meet people where they are to
deliver the care that they need, as you mentioned, conveniently
and in hours that fit people's real lives.
Addiction and mental health challenges affect people of all
ages, incomes, and backgrounds, which is why it is essential
that Community Health Centers remain accessible. Can you
explain the importance of including mental and behavioral
health funding for Community Health Centers in future funding
packages?
Ms. Johnson. Thank you so much for the question. We--you
know, this is just vital to what primary care needs to be going
forward. Family--an individual doesn't experience a mental
health condition separate from their physical health condition.
They are one person, and we need to be able to treat them where
they--and when someone raises their hand and says they need
help, we need to be able to meet that moment and help them.
Today health centers are only able to meet about 25 percent
of the mental health needs of their patients and about 6
percent of the substance use disorder needs of their patients.
We clearly need to do more to make sure that we are taking care
of families and meeting their critical healthcare needs.
Ms. Kuster. Great. Well, thank you so much. I appreciate
all your efforts.
And thank you to the committee for raising this important
conversation about how we can improve access to both healthcare
and mental health and substance use disorder, and improve
workforce. Thank you, and I yield back.
Mr. Bucshon [presiding]. The gentlelady yields back. I now
recognize Mr. Latta from Ohio for his 5 minutes.
Mr. Latta. Well, thank you, Mr. Chair.
And Administrator, thanks for being with us today. You
know, health professional shortages are everywhere. And I know
that when I am out in my district, I don't think I can go into
a facility that--it is not one of these things that is like a
few people, or a sort of many people. I mean, it is
unbelievable, the numbers of individuals that we have to have
filling our healthcare slots out there.
And, you know, it is everything from primary to dental to
mental health, and--as you were just talking about on the
mental health side. But what trends have you seen in the
distribution of healthcare professionals between HPSAs, and how
is this distribution tracked at this time?
Ms. Johnson. Thank you so much for the question, because
you are right, it is not just about producing more healthcare
providers. It is about the distribution of healthcare
providers. Because if we just train more, those folks will go
where, you know, reimbursement is highest, or where they are--
they can get their--make enough revenue to pay down their
medical debts.
That is why the National Health Service Corps is so focused
on not just training new providers but incentivizing them to
practice in the communities that need them most. And we do that
through our Health Professional Shortage Area designations,
where we work closely with States on identifying the provider-
to-population ratios in a community, the need in a community,
the distance to providers in a community, and are able to
define where highest needs are and be able to place National
Health Service Corps members based on need.
And thanks to the resources that we have had over the past
couple of years, we have been able to fund a sizable amount of
the request for that. Without the resources in the President's
budget to sustain those National Service Corps numbers, we
won't be able to place nearly as many.
Mr. Latta. Wait, let me follow up on that, because, again,
I was just out--you know, this is a work period that we just
came back from, so I was on the road extensively. And I know
that, going through some of my rural providers out there, they
are really struggling. And the problem then, of course, is they
say, ``Well, what we try to do is get somebody from a
metropolitan area to come up for 2 to 3 days.'' And so they
have this going back and forth.
But when you are tracking this, I think it is really going
to be important because, again, I don't want to have a
situation where somebody--maybe somebody, they might say that,
oh, they have got somebody up here at this period of time, but
they need somebody there all the time. And so--but, you know,
they are doing everything they possibly can to make sure that
they can make--treat their patients in a timely manner.
Let me go on. You know, I understand that on the--payment
and reimbursement are an issue, and that there are a lot of
ideas on how to expand the workforce and provide timely care.
However, do you believe there are any regulatory barriers that
hinder that workforce growth at this time?
Ms. Johnson. Well, you know, I think that one of the things
that we are looking at with our new proposed healthcare
innovation program is for the healthcare community to come to
us with good new ideas for how to address workforce challenges.
And sometimes what we see in some of those places is folks have
suggested to us there are models that have sort of accelerated
training, or they have, you know, broken through some of the
accreditation issues or licensing issues, or those kinds of
things.
And so what we are hoping is that this new program allows
us to look at creative ideas from the community to break
through any barriers.
Mr. Latta. You know, and again, you know, following up
again on this, because, again, this is one of my concerns--and
I am sure it is everybody's concern--what this is, that
scenario that everybody has in the back of their mind. What
happens when we don't have a sufficient number of personnel to
be in a facility that is, you know, under regulation, so you
have to have X number of people, and all of a sudden they say
we don't have those people, but they have the great need to
serve all these patients that, all of a sudden, they can't do
anymore?
So, you know, here is the horrible thought: What do they
start saying? ``Number 1, we don't accept anybody else in.
Number 2, we have to almost do a triage in there in saying
that, well, for those who we think that don't have as great a
need, we are just going to have to release back to their
families.'' And then what are we going to do?
Ms. Johnson. Well, so I would say, sir, obviously, we have
much more work to do to incentivize people to come into the
healthcare pipeline. But we are looking at those kind of
pipelines. Like, where do we have people who are on the first
ladder in their career that we can get from an LPN to an RPN,
and so that we can get more nurses in the workforce? Where do
we have opportunities to bring high school students, as others
have mentioned, into the workforce? So how do we do
apprenticeship programs?
We have been investing in community health worker
apprenticeship programs to start to get people on a path to the
healthcare workforce. And so, while this conversation is
focused on the National Health Service Corps, we have a host of
investments on the discretionary side related to training more
nurses, physicians, behavioral health providers as part of that
effort.
Mr. Latta. Well, it is really important because, again,
seeing what I saw in the last week, you know, we are doing a
tremendous job from even in our high schools. I saw things that
if--I told the students that I think people have been working
on their Ph.D.s, and we would have been in--back when I was in
high school, what these kids are doing today, absolutely
unbelievable. But we just have to get these people out there.
Mr. Chairman, my time is expired, and I yield back.
Mr. Bucshon. The gentleman yields back. I now recognize Ms.
Kelly from Illinois for her 5 minutes.
Ms. Kelly. Thank you, Chair Guthrie and Ranking Member
Eshoo, for holding today's hearing. Ms. Johnson, thank you for
being here today.
And 1-year postpartum suicide and substance use are the
leading causes of maternal death, with suicide accounting for 9
percent of the maternal mortality rate. Maternal mental health
conditions such as anxiety, perinatal postpartum depression,
and birth-related PTSD are the most common complications of
pregnancy and childbirth, affecting one in five women.
Among those affected, 75 percent go untreated. While women
of color are more likely to experience these conditions. They
are also less likely to seek help. What remains so surprising
is 100 percent of these conditions respond to early
intervention and/or treatment.
So what current resources does HRSA have to help close the
access gap to maternal mental health services?
And what additional resources are needed to improve access
to mental health services for moms?
Ms. Johnson. Yes, thank you so much for the question. It is
such a critical issue. We talk about the maternal mortality
crisis. I don't know that we talk enough about the maternal
mental health needs of individuals and families.
What we have been able to do at HRSA, two programs--we do a
number of things, but two programs that are--I am particularly
excited about in this space that I think are going to make a
real difference.
One, our maternal depression and screening program. This is
a program where what we are trying to do is help--in the same
way we are talking in this conversation about primary care
providers integrating mental health, helping OB-GYNs get access
to mental health experts, and so that if--in real time, through
teleconsultation--so that if you have a pregnant woman in your
office and you have--and you are aware of significant concerns,
you can get real-time teleconsultation access to mental health
providers to help you manage that, so that person isn't sent
off on their own with a referral--good luck getting an
appointment--that it can actually happen in the office.
We haven't had a ton of discretionary funding for this
program, so we have only been able to fund seven States so far.
But this year we got some additional money. We think we will
get up to 14 States. We are very excited about the opportunity
this program presents.
And then second, I would note we have launched--last
Mother's Day we launched the National Maternal Mental Health
Hotline. We have had thousands of calls to the hotline. It is
844--833-9-HELP4MOMS. It is our way of helping moms have a safe
space, pregnant women and family members have a safe space to
have a conversation, confidential conversation, with a
counselor. And we have seen incredible demand for it.
We have--we had a limited amount of resources to launch it.
We have got some more in the last appropriations bill, which is
going to allow us to do more outreach to get--to make awareness
better and continue to bring people in and provide that kind of
support.
Ms. Kelly. That is fantastic to hear. And anything I can do
to help you along with that----
Ms. Johnson. Thank you.
Ms. Kelly [continuing]. I would love to do that.
Shifting gears, 17 individuals die each day waiting for
organ transplant. Black people are four times more likely to
develop kidney failure than White people but are much less
likely to receive a lifesaving kidney transplant. Additionally,
Black people also experience the highest rate of health failure
but receive heart transplants at a lower rate than their White
counterparts. These are tragic inequities that are
unacceptable, and that is why I was glad to see HRSA's
leadership last month in announcing the Organ Procurement
Transplant Network Modernization Initiative--long title.
As our country continues to move forward at a rapid pace,
with new technologies becoming available every day, we owe it
to our constituents to bring our medical practice into the 21st
century and save lives. Yet in a report from the U.S. Digital
Service, the Government's own top technologist said that the
current OPTN contractor lacks sufficient technical capabilities
to modernize the system. And this is one of the many reasons I
am proud to cosponsor with my colleague Congressman Bucshon the
Secure the U.S. OPTN Act.
How would you--how would opening up the management of the
OPTN network to multiple contracts improve outcomes for
patients?
Ms. Johnson. Thank you for the question, Congresswoman.
You know, I have been in this seat for about 15 months.
When I first started in this role, it was crystal clear to me
that we had a lot of work to do here, that the statute was old,
that the systems were--needed to be modernized. And our team
has been working nonstop since then to really focus on what it
is going to take to modernize the system.
And what it is going to take is more competition. And what
it is going to take is us being laser-focused on ensuring we
are getting best-in-class in all of the categories of work
associated with the OPTN. And that is our priority, and that is
what we are going to do. And we appreciate your help in that
regard. The legislative action and additional tools will make
it that much easier for us.
Ms. Kelly. Well, hopefully, we can get this bipartisan bill
passed.
And I yield back.
Mr. Bucshon. The gentlelady yields back. I now recognize
myself for 5 minutes for my line of questioning.
I want to start out by saying one of the ways we can get
more physicians in underserved areas is properly reimburse
primary care doctors for their services instead of continuing
to cut reimbursement in a failed attempt to control healthcare
costs, which--the physicians are only about 10, 15 percent of
the healthcare dollar. And in the long run, this would actually
save us money because it would make our population much more
healthy.
I want to highlight again--Congresswoman Kelly just
mentioned H.R. 2544--I am proud to introduce that with
Congresswoman Kelly. Again, it seeks to improve the system, the
OPTN program, through competitiveness because, according to
increasing numbers of reports, the OPTN struggles to obtain and
distribute organs in an efficient, timely, and appropriate
manner. In fact, it is believed that thousands of donated
organs go to waste each year because the process of obtaining
organs, matching them to a recipient, and transporting them is
not happening effectively. With the technology and expertise
available today, that is just unacceptable. And there
definitely are also disparities in distribution amongst
different populations of our fellow citizens.
This bill allows HRSA to improve the OPTN program. It
clarifies that HRSA does not have to implement a single
contract for all aspects of the program and encourages a
competitive process to choose the best contractors for each
OPTN function. I don't have a question. Those have already been
answered by you. But that is why I feel like legislative action
is necessary.
I also want to say I was a surgeon before I was in
Congress. And during my residency in the early nineties I spent
time on the transplant service at the Medical College of
Wisconsin in Milwaukee, Wisconsin, a strong, solid organ
transplant program at that time, and still is today. And so,
talking to the faculty members when I was a resident, I began
to understand how the system worked, or didn't work, even 30
years ago after what had been put in place 40 years ago. So I
have direct experience with this, and it needs fixed.
Again--I would like to again draw your attention to the
340B program. Multiple Members have talked about it. I think
Dr.--Morgan Griffith really outlined one of the problems that
happened in Virginia. This is widespread, in my view. I have
been working on this for 5 or 6 years.
As you know, Congress failed to establish clear parameters
for the program, in my view, forcing HRSA to try to determine
how it should be run. I am in the process of working with many
others, including the committee, to draft legislation to
increase the transparency in 340B so that Congress and the
public can better understand when the program does or does not
benefit patients. And that is the goal of the program. It was
instituted to make pharmaceuticals available in underserved
populations, including rural America and many areas of urban
America. And that is the goal.
I appreciate that Secretary Becerra, who was here
testifying recently, concurred during a hearing last month that
more transparency is needed. Understanding that we must move
forward in the most efficient, least burdensome manner
possible, I would like to know--and you may have answered some
of this--what data HRSA already collects on 340B. What data
points does HRSA already collect from program participants in
the 340B program?
Ms. Johnson. Thank you for the question. Thank you for your
leadership on this issue.
As I mentioned previously, we are very anxious to work with
you on transparency issues, on accountability issues, because
at the end of the day this is a safety net program that is
vital to many safety net providers, and we want to make sure
that, across the system, that there is accountability and that
resources are going in the appropriate direction.
We obviously--we collect a series of data related to
allocations and acquisition. We do some of that through
mechanisms that are specific to individual providers,
individual manufacturers. And so--but to the extent we have
publicly shareable data, we will get that to you.
Mr. Bucshon. Great, yes. Can you--if you can, commit to
providing that list.
Does HRSA track the total dollar value of 340B drugs that
each covered entity is buying?
Ms. Johnson. We track the total in aggregate.
Mr. Bucshon. OK, in aggregate but not individually.
Am I correct that, up until last year, HRSA did not
regularly post any sales data on the program?
Ms. Johnson. I am not sure that I can speak to what
happened before last year, but we can get you that answer.
Mr. Bucshon. OK. And it is my understanding that in the
past researchers have had to use FOIA requests to obtain
limited sales data showing covered entity purchases at the 340B
price, although information on discounts and chargebacks have
never been provided when requested. Why is that?
Ms. Johnson. So, again, I am really interested, we are
really interested in transparency in this program.
We have found ourselves to be somewhat limited by some
recent Supreme Court decisions related to FOIA issues, but we
will be happy to work with you on what we can.
Mr. Bucshon. Yes, I want to just say I strongly support the
340B program, but we certainly need more transparency.
I yield back. I now yield to the gentlelady Ms. Blunt
Rochester for her 5 minutes.
Ms. Blunt Rochester. Thank you, Mr. Chairman, and thank
you, Administrator Johnson, for your testimony.
Today we are examining several pieces of legislation to
strengthen healthcare access for vulnerable communities and
bolster the healthcare workforce. Having served as Delaware's
deputy secretary of health and social services, our secretary
of labor, and head of personnel, I am particularly pleased that
we are considering H.R. 2411, the National Nursing Workforce
Center Act, legislation I am leading with my Republican
colleague, Congresswoman Young Kim.
This bill will strengthen the nursing workforce and arm
States with the tools that they need to implement solutions
based on local conditions. Many disciplines in the healthcare
sector are facing workforce challenges. But as the largest
healthcare profession, nurses are the canary in the coal mine.
Just last week the National Council of State Boards of
Nursing released new research showing the impact of the COVID-
19 pandemic on the nursing workforce. The report shows that
100,000 registered nurses have left the workforce over the past
2 years due to pandemic-related burnout, and that in total
almost 1 in 5 of the more than 4.5 million licensed nurses in
the U.S. intend to leave before 2027.
As the nursing landscape rapidly evolves, stakeholders need
up-to-date, actionable information on emerging nursing trends,
and this must occur more frequently than once every 4 years. In
HRSA's 2021 Health Workforce Strategic Plan, HRSA acknowledges
that workforce supply and demand data is not static. The
demographics of the Nation's population shift over time, as do
factors such as labor force participation, and that for data
that do exist, data analysis is difficult, as the quality and
granularity vary widely, and data sources, formats, and
occupational definitions are inconsistent.
Based on this assessment and what I am seeing in my own
community, I believe we need a strategy to not only centralize
the study and development of nursing workforce practice and
policy, but we also need to better support State-level entities
in addressing State-specific nursing workforce challenges.
State-based working--State-based Nursing Workforce Centers
who have a consistent mandate and reporting structure to HRSA
can help fill this gap. And a core function of Nursing
Workforce Centers is to collect and analyze data at the State
and local levels. But they can do so much more to support a
more resilient, dynamic, and engaged nursing workforce,
including training, mentoring, and leadership development.
Administrator Johnson, does HRSA's Health Workforce
Research Centers program have the authority to fund a nursing-
focused research or technical assistance center? Yes or no?
Ms. Johnson. Thank you so much for the question,
Congresswoman. Thank you for your focus on this.
And it would be hard to talk about nurses without saying
that we owe them an incredible debt of gratitude for what they
have done historically, and what they have--especially what
they have done in the last several years. And it shouldn't just
be about our gratitude, but it should be in action. And so we
really do look forward to working with you on this issue.
I think we are working with our lawyers to assess our
statutory authority with respect to what we can and can't do
under current regulations, and I look forward to working----
Ms. Blunt Rochester. So the answer is you are not sure.
Ms. Johnson. Yes.
Ms. Blunt Rochester. OK, thank you. How might HRSA
collaborate with State-based entities? And more specifically,
could this collaboration contribute to the stabilization of the
nursing workforce in this country?
Ms. Johnson. We think it is really important across all of
our workforce analysis to work with States. There are academic
centers in many States that are focused on nursing. There are
academic centers focused on other parts of the workforce. It
doesn't make sense for us to do this work alone or to replicate
what is happening on State levels. It should be in
collaboration, and that is our goal, and that is what we hope
our National Workforce Center is doing.
Ms. Blunt Rochester. Great. Thank you, Mr. Chairman. I ask
unanimous consent to enter into the record a statement from my
dedicated colead, Congresswoman Kim, and letters of support
from AARP, the Center for American Progress, the National Forum
of Nursing Workforce Centers, Health Impact, the American
Hospital Association, and the American Health Care Association.
And I want to just quickly shift to the Strengthening
Community Care Act, which I am coleading with Representatives
Joyce, Fletcher, and Stefanik. We are very proud of this bill,
and we know it is very important and timely as we reauthorize
the National Health Service Corps and the Community Health
Center Fund for 5 years. I am going to go right to my question,
because I have, like, 10 seconds.
Since most health centers are already providing care
related to mental health and substance use disorder, as you
mentioned, how can us having a requirement improve access to
these services and help address the opioid crisis?
Ms. Johnson. Thank you for the question. It is--what--we
are doing what we can with what we have. We are nowhere meeting
demand. And so there is an incredible opportunity here in
communities across the country that have been ravaged by the
opioid epidemic to leverage the footprint of healthcare
services that are already in their community to deliver the
kind of substance use disorder services that will get people on
a pathway to recovery.
Ms. Blunt Rochester. Thank you so much.
And thank you, Mr. Chairman. I yield back.
Mr. Guthrie [presiding]. Thank you, I appreciate it.
Without objection, the documents you have requested are
submitted for the record.
[The information appears at the conclusion of the hearing.]
Mr. Guthrie. We appreciate your work on this. I think you
have several pieces of legislation before us today, so--I was
looking at the list. So this might be the Blunt Rochester
hearing today. So thanks for your hard work on these issues.
The Chair now recognizes Mr. Hudson from North Carolina for
5 minutes.
Mr. Hudson. Thank you, Mr. Chairman.
Ms. Johnson, thank you for being here today, and I
appreciate your long history of public service. And I also want
to acknowledge what a feat it must be to juggle over 90-plus
programs. And I really appreciate that, and appreciate you
being here today.
Based on recent reporting, it is my understanding that the
Biden administration is launching a $5 billion-plus program to
accelerate the development of new coronavirus vaccines and
treatments dubbed Project NextGen. I would just like to note
the committee has not been briefed or received any information
on this initiative. So unfortunately, I have to go on what has
been reported in the national media. But I am both concerned
and interested to know where the $5 billion came from for this
program. Reporting that I have read indicates that ``the pot of
money'' was financed through money ``saved from contracts
costing less than originally estimated.''
What are these contracts? I specifically asked Secretary
Becerra when he was in front of this committee just a few weeks
ago about approximately 5 to 6 billion dollars of unexpired,
unobligated funding. And Secretary Becerra claimed this funding
was, in fact, committed and, again, ``in the pipeline to be
signed on the dotted line.'' Was he referring to Project
NextGen?
I have also heard from my Appropriations colleagues this
funding came from the Provider Relief Fund and the American
Rescue Plan funding and was intended for testing. Administrator
Johnson, can you please provide any clarity on this? Was any
amount of funding intended for HRSA Provider Relief Fund
reallocated to the recently announced Project NextGen?
Ms. Johnson. Thank you for the question, sir. I can't speak
to the particulars of the NextGen project. I don't know the
details there and would refer you to our department of budget
experts on that question.
I will say that, as we get to the end of the Provider
Relief Fund allocations, there are some instances where there
are resources that we might have held for applications or for
reviews of reconsiderations, where reconsideration applications
came in less than we anticipated. So there are resources that
are available through the Provider Relief Fund.
Mr. Hudson. But to your knowledge, have those been
transferred to this new project, NextGen?
Ms. Johnson. I believe that--again, the budget office will
be able to answer that for you more directly. I don't know that
resources have to be transferred for that purpose, so----
Mr. Hudson. OK. And then you talked a little bit about some
of these unobligated funds or unspent funds. Can you please
speak to any contracts that you are aware of that ``cost less
than originally estimated'' or were used to subsidize this new
project? Are there any specific----
Ms. Johnson. I am sorry, I don't know the details. I don't
know what that is referring to.
Mr. Hudson. Well, could you get back to us if you talk to
your budget folks----
Ms. Johnson. I am happy----
Mr. Hudson [continuing]. About funds----
Ms. Johnson [continuing]. Happy to----
Mr. Hudson [continuing]. That are transferred to Project
NextGen?
Ms. Johnson. I am happy to talk to the budget team and ask
them to--and raise the questions that you have asked.
Mr. Hudson. I mean, honestly, they will probably respond to
you quicker than they would respond to me.
Ms. Johnson. Well, I----
Mr. Hudson. So if you could get back to us on that, I would
really appreciate it.
Ms. Johnson. Thank you, sir.
Mr. Hudson. And then in your written testimony--just
shifting gears here--I appreciate you mentioned the importance
of assistance to rural communities. I represent a rural
community, and I work very closely with our Community Health
Centers, and they do a tremendous job.
And during a recent visit to one of these--Moncure
Community Health Center--I saw the need for more flexibility,
like the legislation that came out of this committee that
authored the Mobile Health Care Act, which allows them to use
those funds in rural and underserved communities for things
like mobile health units, and we have had a lot of success with
those. We have been able to provide mental health access to
schools that normally wouldn't have access to mental health. As
you know, that is a real crisis right now. So, you know,
anything we can do to continue to offer flexibility to these
rural Community Health Centers, I would encourage you. But that
has been a real success story.
And then Representative Pallone mentioned another critical
need in healthcare today--I hear everywhere I go--is workforce.
And, you know, throwing money at a solution is not always the
best--or a problem is not always the best solution. We have had
some success in North Carolina. Numerous Community Health
Centers have formed partnerships with the University of North
Carolina as well as Meharry, an HBCU, to provide workforce.
One huge success story also has been increased training
resources and furthering wellness activities in Randolph
County, North Carolina, resulting in decreased costs for
employee health insurance over the past 3 years. You know,
these kind of partnerships, this kind of innovation is really
showing results. So I would just encourage you any way that
HRSA can help encourage this kind of innovation and this kind
of creativity, it is working. So we would love to see more of
it.
Ms. Johnson. I very much appreciate that. Thank you. We
actually fund Meharry through a host of our discretionary
programs on workforce training. So I am really pleased to hear
that you have seen these programs in action.
Mr. Hudson. Great, thank you.
Mr. Chairman, I yield back.
Mr. Guthrie. Thank you. The gentleman yields back. The
Chair recognizes Ms. Barragan from California for 5 minutes for
questions.
Ms. Barragan. Well, thank you. Thank you, Mr. Chairman, for
having this important hearing.
Administrator Johnson, our Nation faces a healthcare worker
shortage. Just last week in my congressional district I met
with one of my hospitals who was telling me about the worker
shortage and the impact it is having.
So the worker shortage--and the dental sector is not exempt
from these workforce challenges currently being discussed. The
shortage of dental providers impacts patients' access to oral
healthcare across the country. In fact, research by the ADA's
Health Policy Institute indicates that one in three dentists do
not have full appointment schedules because of staffing issues.
What is HRSA doing to address the dental industry workforce
shortages, particularly with respect to dental hygienists?
And does HRSA have plans to reopen any of the oral health
training programs, such as the State Oral Health Workforce
Program?
Ms. Johnson. Thank you for the question and for
highlighting what is a critical need. Far too often, oral
health gets overlooked when we talk about critical healthcare
issues, and it is essential to overall health, and is a place
where we need to make sure that there are providers in
underserved and rural communities.
We--dentists and dental hygienists are part of the National
Health Service Corps. They are all--dentistry is also an
eligible discipline in the Teaching Health Center GME program.
So we are training dentists directly, and we are supporting
loan repayment for dentists to get into the communities in
need.
And as you mentioned, we have our discretionary programs as
well. And we are, in that regard, limited by appropriations.
And so we will do what appropriations resources allow us to do
in that regard.
Ms. Barragan. Great, thank you. In January the Geiger
Gibson Project on Community Health at George Washington
University noted the potential effect of the Medicaid unwinding
on Community Health Centers, stating that the Medicaid
unwinding is expected to have significant ramifications for
Community Health Centers. The unwinding is estimated to
decrease total health center revenue, with an associated loss
in patient capability of 1.2 to 2 million patients and a
staffing capacity loss of 10 to 18,500 staff members.
Medicaid is a critical funding source for Community Health
Centers. Medicaid is really important in my congressional
district, very working class. And I am concerned that the loss
of Medicaid coverage for millions of patients will decrease the
ability of health centers to serve all the patients who need
care, not to mention the number of Latinos. As a chair of the
Congressional Hispanic Caucus, I am concerned about the amount
of Latinos that may lose coverage.
How does HRSA plan to help Community Health Centers as the
Medicaid population is expected to decrease? And is there more
Congress can do to help?
Ms. Johnson. Well, thank you for raising it. We share your
concern. It is vitally important that people who remain
Medicaid-eligible don't lose Medicaid coverage for some
paperwork or bureaucratic reason, because they don't get the
right paperwork or don't know to respond. That is why we are
really focused on making sure all of our enrollment assistors,
all of the ways that we can partner with health centers and
with other community organizations, our other grantees to get
the word out to people that they are--that these reviews are
coming, and they need to be able to respond to them, and to
support people in that is critical.
But there are going to be people who are transitioning off
of coverage. So we want to also make sure that they get into
marketplace coverage as quickly as possible. That matters not
just for those individuals and their families, but for the
fiscal viability of the health centers that we are talking
about here today. And so that is why it is so important that we
work together on the continuation of mandatory funding for
these providers.
Ms. Barragan. Great, thank you. My last question is just a
really general question.
When I had my meeting last week with Long Beach Memorial
about the worker shortage issue--I have a sister who is a nurse
too. You hear firsthand the stories of how challenging it is
for those in the field. You know, what can we be doing?
I know that there is, you know, the children's, you know,
medical education, like, training program and the adult version
of that, and I know there is a huge disparity in funding there.
We know that there is a, you know, nursing shortage bill. But
what would you--be your suggestion on how to best address this?
Ms. Johnson. The workforce issues writ large? Yes?
Ms. Barragan. Yes, the shortages that we are having.
Ms. Johnson. Yes. The path we have laid out in the
President's budget is sustaining the commitment we have made to
National Service Corps at the level we have made it over the
next 3 years, training more nurses by solving some of the
bottleneck issues that make it harder for people to get into
nursing because we don't have enough faculty, training more
mental health and substance use providers through our existing
programs.
Our budget proposal would allow us to train 18,000 new
providers, and ensuring that we create our Health Care
Workforce Innovation Program to develop new models for more
rapidly training people to get into the workforce.
Ms. Barragan. Thank you. We also need to make sure that
people can afford to go to nursing school, student loan debt
relief, and other programs of that nature.
Thank you, and I yield back.
Mr. Guthrie. Thank you. The gentlelady yields back. The
Chair now recognizes Dr. Joyce from Pennsylvania for 5 minutes
for questions.
Mr. Joyce. Thank you for yielding, Chairman Guthrie, and
thank you for holding this important hearing.
One of the most consistent issues that I have heard in my
district in Pennsylvania is the shortage of physicians and
healthcare workers and barriers to access to primary care. For
this reason, last week I introduced H.R. 2559, the
Strengthening Community Care Act, with Chairwoman Stefanik,
Representative Blunt Rochester, and Representative Fletcher.
And I would further like to thank Representatives Carter,
Bilirakis, DeGette, and Spanberger for their support of this
measure.
This critical piece of legislation would provide for
Community Health Centers across the country, including centers
in my own district like Keystone Rural Health Center, Broad Top
Area Medical Center, and Heineman Area Health Center, which
helps serve the needs of over 250,000 individuals, patients in
Pennsylvania's 13th district.
This bill will also reauthorize the National Health Service
Corps, which supports more than 20,000 primary care medical,
dental, and behavioral health providers through scholarships
and loan repayment programs.
I, like many on this panel, have heard from communities
throughout my district about the need for expanded access to
behavioral healthcare and substance use disorder treatment, and
Community Health Centers play an incredibly valuable role in
providing mental and behavioral healthcare to vulnerable
populations.
Administrator Johnson, what percentage of CHCs provide
these specifically behavioral health services in communities
today in America?
Ms. Johnson. Yes, thank you for the question. I think most
health centers try to provide some level of mental health
services, but it is a significantly smaller percentage. We can
get to the particulars on substance use disorder.
What we know is that, even when they do, they can only meet
about a quarter of the demand for mental health services and
about 6 percent of the demand for substance use disorder
services.
Mr. Joyce. Thank you. And how important is the stable and
sustainable Federal funding in the Strengthening Community Care
Act to our health centers' ability to continue to provide this
access to behavioral healthcare?
Ms. Johnson. Yes, thank you. I don't know that I have seen
the particulars of the bill. I will say, writ large,
sustainable, predictable funding makes an incredible difference
to retaining the health workforce, to delivering services in
the community, to planning for what you can do going forward to
surging to meet critical health needs.
Mr. Joyce. Again, I thank you. How do Community Health
Centers typically comply with the requirement to provide
emergency services and ensure continuity in primary care
services that a patient should receive?
Ms. Johnson. So Community Health Centers are required and
closely monitored by us to ensure that they have in place all
of either directly or contracted relationships that allow them
to comply with all of the section 330 requirements.
Mr. Joyce. And on an additional matter, we are hearing from
Community Health Centers and other providers who rely on 340B
that large PBMs are pickpocketing their 340B savings through
predatory contracts and without sharing any of the savings with
their patients.
There has been plenty of talk about the need for more
transparency on how 340B is being used. You mentioned earlier
in the discussion here today that you collect specific data at
HRSA. But on this matter specifically, can you speak to whether
HRSA can address these issues through the existing authority,
or does it need Congress to intervene?
Ms. Johnson. I believe, Congressman, that we would benefit
from your assistance in this regard, because we are continually
reaching roadblocks when it comes to our authority. So we would
benefit from working with you on this topic.
Mr. Joyce. And I agree with you. It is time for Congress to
intervene and stop those roadblocks from occurring.
Once again, I thank you for being here today.
And Mr. Chairman, I yield the remainder of my time.
Ms. Johnson. Thank you.
Mr. Carter [presiding]. The gentleman yields. The Chair now
recognizes himself for 5 minutes for questions.
Ms. Johnson, thank you for being here. I appreciate this
very important--obviously, what you do, and this agency is
extremely important.
I too want to chime in, as I know some of my colleagues
have already, about the 340B program because, as the oldest
pharmacist in Congress, I am very concerned about it, and I am
very concerned because of my FQHCs and because of the
hospitals, the rural hospitals.
I represent the entire coast of Georgia and a lot of south
Georgia. As we like to say in Georgia, there are two Georgias:
There is Atlanta, and everywhere else. And I represent
everywhere else. And a lot of that is rural areas. And
certainly, the rural hospitals depend on this program, and they
have been very concerned about what has happened with some of
these manufacturers who are refusing to participate. And quite
honestly, I can't blame them.
I think the program needs guardrails. It does not need to
be eliminated. It needs to go back to what it was intended to
be, what it was intended to serve, and the population that it
was intended to serve. Unfortunately, as has been pointed out,
there are a lot of hospitals, a lot of healthcare systems that,
unfortunately, are not using it and utilizing it the way that
it should be.
So having said that, I know that there was a report in--by
the New York Times, the Wall Street Journal, and other outlets
by investigative journalists that some of the nonprofit
hospitals are doing exactly that, and that is that they are--
some of the DSH hospitals are using the program to pad their
profits without regard to the needs of the vulnerable patients.
And the second is how--the second thing that I want to
point out is, of course, the PBMs. And I am no fan of the PBMs,
as I am sure you know, but they are getting into the 340B
program. And it doesn't surprise me one bit that they are. But
they are getting in. They are stealing discounts that were
intended for the patients.
Both of these issues need to be addressed. Both of them
need to be addressed. And just as my colleague Dr. Joyce just
mentioned, we want to help, and legislatively, if we need to.
And as you indicated, it appears that we need to.
So let us help you. There has been suggestions of starting
a 340C program--I am sure you have heard of that--just to
quantify and to specifically identify who this program is to be
for.
Now, I am not suggesting that all DSH hospitals are abusing
the program or pushing the envelope on the program, if you
will. But there are those that are doing that, and particularly
in the oncology practices, particularly with cancer patients.
And that is a big concern as well. Some of these healthcare
systems are buying out oncology practices for no other reason
except to utilize the 340B program. And that is not what it was
intended for. You know that as well as anyone.
So again, we stand ready to help you with any kind of
legislation that you need.
Specifically, what is the agency doing to curb these
abuses?
I know we have got a couple of lawsuits that are out there
right now, and we are expecting to hear the results of some of
them, hopefully, soon.
Ms. Johnson. Yes, thank you for raising the issue. We have
been taking action such as, you know, when--where we have seen
manufacturers not selling to covered entities via their
contract pharmacy arrangements, we have sent violation letters
to manufacturers in that instance. We have--that is the source
of a considerable amount of litigation, and our authority is
being challenged in that regard.
We also recently sent a series of letters just to covered
entities as part of our ongoing compliance work with questions
containing--concerning their use of--you know, their compliance
with covered entity requirements.
We are working to use all the tools that we have. We
recognize that there--that we would benefit from additional
tools here for the--because we share the goal of accountability
in this program.
Like you, we recognize there is a critical role for 340B
for safety net providers and community--across community. It
makes a real difference. But we also want to make sure that
there is accountability.
Mr. Carter. Good, good. Very quickly, with what little time
I have left, Community Health Centers have been successful in
expanding access to affordable and quality healthcare all
throughout my district, and I am very proud of that.
Last year I was proud to support the Mobile Health Care Act
that gave Community Health Centers the flexibility to use
Federal funding and establish new mobile unit delivery sites,
and many of them have done that to the benefit of a lot of
people in our rural area. So how will the additional
flexibility around new access points funding support mobile
health units and Community Health Centers' ability to reach
more underserved communities and patients, which is what we
want them to do?
Ms. Johnson. Yes, I mean, the provisions in our budget that
are really about trying to do more access points is because
what we hear from Community Health Centers again and again is
we could better reach the population who needs us most if we
had a little more startup resource to get into a few more
communities. And that is what we--that is why we included that
in the budget.
Mr. Carter. Good. Thank you very much, again, for being
here today.
My time is expired, and at this time I am going to
recognize the gentlelady from Washington, Dr. Schrier, for her
5 minutes.
Ms. Schrier. Thank you, Mr. Chairman.
And thank you, Administrator Johnson, for coming today to
speak on these critical programs that strengthen our healthcare
provider pipeline and bolster our healthcare workforce.
First let me just say about the Special Diabetes Program, I
have type 1 diabetes, and I just want to thank Representatives
DeGette, Bilirakis, Ruiz, and Cole for their work to
reauthorize the Special Diabetes Program and the Special
Diabetes Program for Indians. They are vital programs that can
help ensure progress on predicting and delaying, treating,
possibly curing one day with an artificial pancreas--something
that I have been hoping for for 38 years now. These programs
are also critical to helping patients manage diabetes and
complications, and I am extremely supportive and look forward
to their passage.
Second, I want to highlight, as some of my colleagues
already have, the shortage of providers in the U.S., and we are
feeling this most acutely in rural areas and underserved areas.
But we saw early retirements and, really, mass resignations,
much of that related to the pandemic. So we need a bigger
pipeline and a faster pipeline for new providers, and we also
need ways to incentivize those providers to practice in rural
communities like parts of my district and in underserved
communities.
What I have heard in some of the Community Health Centers
in my district--like HealthPoint, for example--they have
highlighted the importance of stable and consistent funding for
Teaching Health Center Graduate Medical Education. In fact,
some of the residents who I met were pretty anxious that the
funding for their program might dry up before they finished
their 3-year residency program.
So, Administrator Johnson, Ranking Member Pallone noted the
importance of sustained and stable funding for these programs,
along with several of my colleagues. Can you talk about why
stability of funding is so important for Community Health
Centers and graduate medical education to continue to generate
providers in rural areas?
Ms. Johnson. Thank you so much for the question. We ask a
lot of Community Health Centers, and then we ask a lot of
residents who come to train in Community Health Centers. We
want them to manage people who have complex health conditions,
who lead complex lives, and ensure that they have a usual
source of care and are available to them as readily as possible
so that they are as healthy as possible and we are keeping
people out of emergency rooms and we are getting them primary
care. All of that is challenging work on a good day.
When the source of your funding is uncertain and variable
and not guaranteed for the full life of your time in residency
or for the full life of your budget planning as the head of a
health center, that is very distressing and hard for us to
recruit residents. It is hard for us to retain leadership in
health centers. It is hard for our health centers to recruit
staff. All of that is difficult without sustainability and
without really understanding the growth path that we know
health centers need to be able to continue to meet demand by
having extended hours, by having more sites.
Ms. Schrier. Thank you. I don't recall when I graduated
from medical school having these rural opportunities, distant
opportunities, or even having to think about whether a
residency program that I chose to start would have funding all
the way through. And so I can understand that anxiety.
You know, I also wanted to highlight some of the work being
done on the ground in Washington State by our Community Health
Centers and Teaching Health Centers. Both Columbia Valley
Community Health, CVCH, and Community Health of Central
Washington offer these rural residency training programs. In
fact, Washington State University's medical school has been a
big driver of this.
I was wondering if you could talk specifically about rural
residency programs and why they are so important for
maintaining a workforce in rural communities.
Ms. Johnson. Yes, it is just--it is hard to start up a
residency program. It is--it takes a lot of work. It takes
getting accredited. It takes having the staff and the faculty,
and it takes recruiting a strong faculty and a good curriculum
and all of that work. That is hard to do in a rural area if you
don't have some support.
And so our Office of Rural Health Policy is able to support
the development of rural residency programs to get them on the
path so that then they can come into other GME programs, and it
makes a huge difference in communities across the country.
Ms. Schrier. Thank you. We talked about see one, do one,
and teach one, and this is reminding me of that. Go to a rural
area, train there, stay there, teach the next generation of
rural providers. So thank you very much.
I am out of time. I yield back.
Ms. Johnson. Thank you.
Mr. Carter. The gentlelady has yielded. The Chair now
recognizes the youngest pharmacist in Congress, the gentlelady
from Tennessee, Mrs. Harshbarger, for 5 minutes.
Mrs. Harshbarger. Thank you, Mr. Chair, and thank you,
Administrator Johnson.
You know, I represent a rural district in east Tennessee,
and I believe your agency reports that more than 80 percent of
rural counties in the U.S. are considered medically
underserved. Does that sound about right, 80 percent?
Ms. Johnson. I would have to validate that for you, but I
agree with you.
Mrs. Harshbarger. But I have seen statistics that only one-
third of NHSC placements are in rural communities. And after
they complete a typical 2-year commitment, too many of those
members leave for higher-paying jobs. In part, they--to
continue paying down their school debt, for example.
And I guess my question to you is, what can we do to ensure
that the NHSC adequately serves the country's rural, medically
underserved areas?
Ms. Johnson. Thanks for the question, because this is a
great part of the National Service Corps that is not totally as
well understood, which is we will further incentivize you after
you complete your first obligation with us. We will give you a
continuation and continue to help pay down more of your debt if
you stay in the community you are in.
So we have--I actually just visited a site in a rural
community where we had people who had been there for more than
the 2-year service commitment because we were continuing--as
long as they had eligible debt, we were continuing to help them
pay down. And they were starting a family, they were going to
live there----
Mrs. Harshbarger. Well----
Ms. Johnson [continuing]. Because that is where they----
Mrs. Harshbarger. Yes, we want them to. You know, we need
to look at innovative solutions to keep these physicians in the
area.
And I helped introduce a bipartisan Rural American Health
Corps Act with David Kustoff here in the House and Senator
Blackburn in the Senate. And I would just recommend my
colleagues sign on to that legislation. And it is sort of a
sister program to NHSC, and it helps with loan repayment in a
lot of ways. So--and I would love to work with you for
technical feedback on that bill. So----
Ms. Johnson. We would be----
Mrs. Harshbarger [continuing]. That would be----
Ms. Johnson. We would be delighted to do that. Thank you.
Mrs. Harshbarger. Absolutely.
But I do want to talk about yesterday the administration
announced a $1.1 billion program to continue to provide COVID-
19 vaccines and therapeutics to underserved Americans, the HHS
Bridge Access Program. And it is my understanding that 1.1
billion to fund this program was pulled from the Provider
Relief Fund. And what I want you to do, can you confirm that
that 1.1 billion came from the HRSA Provider Relief Fund for
this new, unrelated program?
Ms. Johnson. We had previously been funding supports and
services for individuals who are uninsured. And as the--as
vaccines and therapeutics transitioned to commercialization, it
has been recognized that it would be very important that we are
reaching underserved communities and uninsured communities. And
so, as an allowable use of Provider Relief Funds, funds are
being used to support----
Mrs. Harshbarger. So is that----
Ms. Johnson [continuing]. Program.
Mrs. Harshbarger. Will that program be ended in December of
2024?
Ms. Johnson. I believe that is accurate.
Mrs. Harshbarger. OK. I guess my question is, how did you
come to that specific $1.1 billion number that you need between
now and next December?
Ms. Johnson. Yes, I believe that--and again, I would need
to consult with our colleagues across the department who helped
design the program.
Mrs. Harshbarger. Yes.
Ms. Johnson. But I believe it was looking at where
uninsured needs are, and where we thought, because of the cost
associated with administration of these vaccines and
therapeutics----
Mrs. Harshbarger. Well----
Ms. Johnson [continuing]. What that would look like.
Mrs. Harshbarger. OK, that brings me to another question.
Was there an assumption that annual boosters would be
recommended and incorporated into that 1.1 billion?
Ms. Johnson. I don't know the answer to that question, but
I am happy to get back to you on that.
Mrs. Harshbarger. OK. If you could find that, because--I
guess I am asking that because assumptions were made around
anticipated demand, and there has clearly been a decrease in
COVID-19 vaccine uptake. So, you know, that is just my
question: How did you get to that 1.1 billion?
But if you could do that, that would be fantastic----
Ms. Johnson. I am happy to follow up with you on that
point. Thank you.
Mrs. Harshbarger. And I know I have got a minute left. I
wanted to talk about Countermeasures Injury Compensation
Program, and I thank you for your recent response to the
congressional letter that was sent by our colleague, Rich
McCormick of Georgia. And a lot of the colleagues here signed
on to that.
In our letter we expressed concerns over the delays that
are being experienced by individuals making claims under the
CICP and sought information regarding how your agency intends
to address the barriers to compensation reported by our
constituents. My question is, how many reviewers are being used
for the nearly 12,000 COVID vaccine injury claims on file?
Ms. Johnson. I believe we have done a series of hiring
because we have recognized the need to grow this program,
which, you know, historically, for the 10 years it had been
around, had only gotten 500 claims over the life of the
program.
Mrs. Harshbarger. Yes.
Ms. Johnson. So we have scaled up hiring.
Mrs. Harshbarger. Many more now, yes.
Ms. Johnson. And I believe we are at 38 now.
Mrs. Harshbarger. Thirty-eight? How is the CICP
prioritizing these claims? And in particular, is there any
focus on death claims?
Ms. Johnson. We are--I will need to get back to you on the
particulars----
Mrs. Harshbarger. OK.
Ms. Johnson [continuing]. Of that. Yes.
Mrs. Harshbarger. Yes, well, I have got other questions,
but I will submit them to you.
And with that, thank you for being here----
Ms. Johnson. Thank you.
Mrs. Harshbarger [continuing]. And I yield back.
Mr. Carter. The gentlelady yields back. The Chair now
recognizes the gentlelady from Iowa, Dr. Miller-Meeks.
Mrs. Miller-Meeks. Thank you very much, Chair Carter, and
thank the committee for having this hearing.
So let me first say that I am a physician as well as a
former director of the Iowa Department of Public Health, so
very familiar with Health Professional Shortage Areas, HPSA,
our Maternal and Child Health Grants.
But I just want to say that workforce is a complicated
issue, and it is complicated because it--when you are looking
at physician workforce, especially, people just don't locate
where reimbursement is the highest. And let me just say that in
our small community of 26,000 people we had a very vibrant
medical community. And I am fully supportive of our FQHC, but
our FQHC also decimated our provider community. Our FQHC does
not pay property tax, which put an increased burden on the
private practices that got displaced, which were paying
property taxes.
You know, who pays for electronic health records when you
have to institute that, or electronic billing, or all of the
other mandates that individual practices have had?
And so you have had from the start and the inception of the
Affordable Care Act, 50 percent of physician practices were
independent or a small group, meaning not consolidated. And now
only 20 percent of those practices. So the majority of
physicians are now either hospital employees or large group
employees.
With that, noticing in your testimony you had mentioned
that you had reached a milestone of 20,000 family medicine
providers, pediatricians, obstetricians--I won't go through the
entire list. That was a historic high. So is that 20,000 people
that are in practice now, or is that 20,000 people over the 50
years?
Ms. Johnson. That is 20,000 people who are in the field
today.
Mrs. Miller-Meeks. OK. You also mentioned that you have a
retention rate of 2 years beyond the service obligation. What
is the current service obligation in the National Health
Service Corps?
Ms. Johnson. The service obligation is 2 years for the
first award, and then the options for continuations depending
on allowable----
Mrs. Miller-Meeks. And what is an award?
Ms. Johnson. $50,000.
Mrs. Miller-Meeks. So 2 years for each $50,000 in loan----
Ms. Johnson. Two years for the first $50,000, that is
right.
Mrs. Miller-Meeks. Of loan repayment.
Ms. Johnson. Loan repayment.
Mrs. Miller-Meeks. OK. And so what is the total cost of the
program?
Ms. Johnson. The total appropriation for the National
Service Corps today--this year we are at $417 million.
Mrs. Miller-Meeks. And what is your overhead cost--i.e.,
how much of that money goes out to loan repayment, and how much
of that stays within the institution?
Ms. Johnson. I don't know the answer to that off the top of
my head.
Mrs. Miller-Meeks. Could you get me the answer to that?
Ms. Johnson. Absolutely.
Mrs. Miller-Meeks. And so--and what is the retention rate
beyond 2 years? Because I can tell you what the retention rate
is on our J-1 visa programs beyond the 3 years of obligation.
Ms. Johnson. Beyond the 2 years--the first 2 years beyond
the 2 years of obligation, our retention rate is 86 percent.
Mrs. Miller-Meeks. How many stay beyond? So after 2 years--
so, like, for 5 years, what is the retention rate?
Ms. Johnson. I have--what I can tell you is the--like,
after the completion rate of 2 years, the 2 years that
followed--at the end of the 2 years that follow that, the
retention rate is 86 percent.
Mrs. Miller-Meeks. OK. Thank you for clarifying that.
Are you also aware of--in the National Residency Matching
Program, have you looked at the stats on matching rates for
family practice and emergency medicine?
Ms. Johnson. We keep abreast--our team keeps abreast of
matching rates.
Mrs. Miller-Meeks. OK. And so is the matching rate 100
percent for family practice?
Ms. Johnson. I don't know the answer to that off----
Mrs. Miller-Meeks. The answer to that is no, and you just
told me that you keep track of those.
Ms. Johnson. Our team keeps track of that. That is correct.
Mrs. Miller-Meeks. OK. So the matching rate for family
practice--we do not fill the number of slots that are
available. And if you look at a university academic medical
center, their slots will be 100 percent filled. Those at a
training health center are not 100 percent filled.
So--and when we are talking about increasing providers,
what is it that we can do to increase or narrow that delta
between the number of slots that are available and the number
of unfilled positions? And 25 percent of those positions are
currently filled by foreign medical graduates, which I think is
great.
Ms. Johnson. You know, it is critically important that we
have as much lead time on recruitment. And so that is why we
think stability in the program is really important, because it
is hard to recruit. You know this better than I do. It is hard
to recruit----
Mrs. Miller-Meeks. Well, the delta has been increasing. So
I can send that data to you. I should have put up a graph.
Ms. Johnson. No, it--but it----
Mrs. Miller-Meeks. But the delta is increasing. So from--
even from, you know, 2013, prior to the pandemic, there has
always been a gap between the number of programs offered and
the fill rate. That delta has been increasing, certainly a
little bit exacerbated by the pandemic, but it was also fairly
significant before the pandemic.
Ms. Johnson. Yes, there have always been challenges with
the fact that the funds have to be renewed. And early on in the
program there were challenges with the stability of the fact
that the dollars were allocated on the fiscal year, not the
academic year.
Mrs. Miller-Meeks. OK, thank you for that. I would say to
investigate that more.
My last question is, you know, as a physician I practice, I
see patients on weekends. I see patients at night when I am
practicing. So why do we have to have 250 million investment to
extend office hours?
I would just say you have to have evening and weekend
office hours. As a Federal Government, if we are subsidizing an
FQHC, a Training Health Center, a Community Health Center, I
would make that part of that program, is that they have
extended office hours in order to be able to adapt to and
respond to their patient consumer demand.
Thank you. I yield back.
Mr. Carter. The gentlelady has yielded back. The Chair now
recognizes the gentleman from Texas, Mr. Crenshaw, for 5
minutes.
Mr. Crenshaw. Does that mean I can schedule an eye
appointment with you? I didn't know that. All right.
Mrs. Miller-Meeks. I would see you.
Mr. Crenshaw. I need a checkup.
Mrs. Miller-Meeks. I would drive you to your----
Mr. Crenshaw. I got issues. All right.
Thank you for being here. Look, when we evaluate these
programs--I agree with my colleague here about the need to use
our money wisely. We have to assess how effective the money is
that we are spending. So I want to drill down on a couple of
policies, make sure we are actually strengthening our access to
care and continuity of care.
You know, many of the programs we are talking about today
are meant to advance primary care. That is a big passion of
mine. I think that is where any patient enters the healthcare
system, so that is where, legislatively, we should enter
healthcare reform. And look, I think there's a few
opportunities that we could look at here to make this better.
Inflation, soaring workforce costs, that has caused a lot
of problems. It means it is really hard to recruit health
professionals and retain them. This is particularly true for
Community Health Centers. So I would like to submit a record--
for the record a statement from Lone Star Family Health Center,
which serves thousands of people in my district to show that
these workforce challenges are real for them as well.
Community Health Centers are supposed to improve access to
primary care services that can reduce costs to public insurance
programs, while also preventing emergency room visits that are
extremely costly. So that is the value-add that we are looking
for. But when you can't hire anyone--and we are not just
talking about physicians here, we are talking about dental
hygienists, we are talking about medical assistants--it becomes
pretty difficult to provide that care.
So I have supported legislation to remove unnecessary red
tape for licensing medical professionals. Can you comment on
this in general terms?
What do you need to help us hire more people, make it
easier to hire more people? What are the barriers that we need
to overcome?
Ms. Johnson. Thanks for the question. One of the things
that we have been working on lately is ensuring that we are
linking some of our grant dollars to apprenticeship programs so
that we are not just training, but we are training and doing
on-the-job training as well so that we can prepare people for
that first step in the health professions career ladder and
then really working to bring people up the career ladder as we
move people into the healthcare workforce.
We also in our budget this year have a new initiative--
proposed initiative--that we call our Health Care Workforce
Innovation Proposal, which is really about addressing some of
the key barriers, getting ideas and new innovative ways to do
healthcare training and to try to scale what works best.
Mr. Crenshaw. Is it you are trying to reform training? Can
you be more specific? I am curious about that.
Ms. Johnson. So I think that, you know, what we hear from
some places is maybe the training period is longer than it
needs to be----
Mr. Crenshaw. OK.
Ms. Johnson [continuing]. Or maybe we could do some things
creatively to match people differently, those kinds of things.
Mr. Crenshaw. OK, that is good. Licensing reform, any
thoughts on that?
Ms. Johnson. You know, we--through some of our telehealth
work we have actually been working on the compacts that States
use to--in health professions to ensure that providers can work
across State lines. We are really interested in ways to
encourage those kind of best practices.
Mr. Crenshaw. OK. I think you would like the bill that we
are supporting. I hope we can--I hope we could pass that.
As you know, National Health Service Corps is supposed to
be a deal where physicians receive scholarships and loan
repayment in exchange for practicing in at-need communities.
But a recent study prepared for the Department of Health and
Human Services suggests clinicians who don't participate in
that, without those benefits, actually practice in Health
Professional Shortage Areas more often and for longer than
those who do. So that tells me we might be wasting money on
some of these folks.
There was an average 13 percent gap between nonprogram
providers and participating providers. That is just strange. So
how long--I have a couple of questions. How long does the
average National Health Service Corps participant practice in a
shortage area after their obligation is complete?
I think I am repeating these questions, but----
Ms. Johnson. Yes, and so there is the base obligation to
stay in the service. They have a service obligation to stay for
2 years. If they get a continuation, sometimes they stay for
multiple years.
And our data is--where we look 2 years after they complete
their service obligation, 86 percent of people are still in
underserved communities.
Mr. Crenshaw. OK. There is obviously some kind of problem
here, isn't there? So are we not using this money correctly? Is
there better ways to incentivize, or at least exploring better
ways to incentivize practitioners in those underserved areas?
Ms. Johnson. We are always looking for ways to continue to
grow the workforce in the communities that need them the most,
which is why we also have the Teaching Health Center program,
which is about not just--you know, loan repayment is about
getting people there who are already through residency.
Teaching Health Centers is actually about doing the residency
in the community where you want people to practice. And then we
also have National Health Center scholarship programs, where
people make the commitment as part of their medical school
education.
Mr. Crenshaw. OK. Well, I am out of time.
Thank you, I yield back.
Mr. Carter. The gentleman yields back. I believe that is
all the witnesses.
I ask unanimous consent to insert in the record the
documents included on the staff hearing documents list.
Without objection, that will be the order.
[The information appears at the conclusion of the hearing.]
Mr. Carter. I remind Members that they have 10 business
days to submit questions for the record, and I ask the
witnesses to respond to the questions promptly. Members should
submit their questions by the close of business on May 3rd.
Ms. Johnson, thank you for being here.
Ms. Johnson. Thank you.
Mr. Carter. I appreciate it, and appreciate the work that
your committee--your agency does.
Without objection, the subcommittee is adjourned.
[Whereupon, at 12:35 p.m., the subcommittee was adjourned.]
[Material submitted for inclusion in the record follows:]
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